Bone metabolism biomarkers in walking children with cerebral palsy

Abstract

Backgrоund. Osteoporosis is an important factor in the pathogenesis of orthopedic manifestations in children with cerebral palsy. It was previously demonstrated that children with cerebral palsy have specific changes in bone metabolism, which can cause changes in laboratory parameters compared with other orthopedic patients without neurological backgrounds.

Aim. The aim of this study was to assess bone metabolism biomarkers in children with cerebral palsy, identifying distinguishing characteristic patterns in comparison with patients with orthopedic pathology without neurological backgrounds.

Materials and methods. This study evaluated the concentrations of calcium, phosphorus, β-cross laps, osteocalcin, vitamin D, CICP, and alkaline phosphatase in the blood serum of 50 children with cerebral palsy aged between 6 to 12 years with GMFCS levels I–III. The control group consisted of 50 patients with plano-valgus deformities of the feet.

Results. The alkaline phosphatase activity in the group of children with cerebral palsy was 170.25 ± 59.35 u/L, while in the control group it was 145.58 ± 46.29 u/L; the CICP concentration in the study group was higher than in the control group (324.01 ± 174.10 and 269.68 ± 240.98, respectively). The concentration of β-cross laps, osteocalcin, calcium, and vitamin D in the study group was lower than in children with flat feet.

Conclusions. This study demonstrated multidirectional changes in the biomarkers of bone metabolism that are characteristic of walking children with cerebral palsy. These changes are characterized by a corresponding increase in the activity of osteoresorption and osteoreparation. This makes it possible to justify the combined use of metabolites and metabolic activators (calcium and vitamin D) and drugs that suppress osteoresorption (bisphosphonates) for the prevention and treatment of osteoporosis in children with cerebral palsy.

Keywords

bone metabolism / biomarkers / cerebral palsy

References

[1] Щеплягина Л.А., Моисеева Т.Ю. Проблемы остеопороза в педиатрии: возможности профилактики // РМЖ. – 2003. – Т. 11. – № 27. – С. 1554–1556. [Shcheplyagina LA, Moiseeva TY. Problemy osteoporoza v pediatrii: vozmozhnosti profilaktiki. RMZh. 2003;11(27):1554-1556. (In Russ.)]

[2] Ward LM, Konji VN, Ma J. The management of osteoporosis in children. Osteoporos Int. 2016;27(7):2147-2179. https://doi.org/10.1007/s00198-016-3515-9.

[3] Sees JP, Sitoula P, Dabney K, et al. Pamidronate treatment to prevent reoccurring fractures in children with cerebral palsy. J Pediatr Orthop. 2016;36(2):193-197. https://doi.org/10.1097/BPO.0000000000000421.

[4] Marrani E, Giani T, Simonini G, Cimaz R. Pediatric osteoporosis: diagnosis and treatment considerations. Drugs. 2017;77(6):679-695. https://doi.org/10.1007/s40265-017-0715-3.

[5] Bachrach LK. Consensus and controversy regarding osteoporosis in the pediatric population. Endocr Pract. 2007;13(5):513-520. https://doi.org/10.4158/EP.13.5.513.

[6] Lewiecki EM, Gordon CM, Baim S, et al. Special report on the 2007 adult and pediatric Position Development Conferences of the International Society for Clinical Densitometry. Osteoporos Int. 2008;19(10):1369-1378. https://doi.org/10.1007/s00198-008-0689-9.

[7] Арсентьев В.Г., Асеев М.В., Баранов В.С., и др. Исследование минеральной плотности костной ткани у детей и подростков с дисплазиями соединительной ткани // Педиатрия. Журнал им. Г.Н. Сперанского. – 2010. – Т. 89. – № 5. – С. 73–77. [Arsent’ev VG, Aseev MV, Baranov VS, et al. Issledovanie mineral’noy plotnosti kostnoy tkani u detey i podrostkov s displaziyami soedinitel’noy tkani. Pediatriia. 2010;89(5):73-77. (In Russ.)]

[8] Weber DR, Boyce A, Gordon C, et al. The utility of DXA assessment at the forearm, proximal femur, and lateral distal femur, and vertebral fracture assessment in the pediatric population: the 2019 official pediatric positions of the ISCD. J Clin Densitom. 2019;22(4):567-589. https://doi.org/10.1016/ j.jocd.2019.07.002.

[9] Каладзе Н.Н., Урсина Е.О. Характеристика структурно-функционального состояния костной ткани и минерального обмена у детей, больных церебральным параличом // Вестник физиотерапии и курортологии. – 2017. – Т. 23. – № 3. – С. 50–57. [Kaladze NN, Ursina EO. Characteristics of the structural-functional state of bone tissue and mineral exchange in children, patients with cerebral paralysis. Vestnik fizioterapii i kurortologii. 2017;23(3):50-57. (In Russ.)]

[10] Yaşar E, Adigüzel E, Arslan M, Matthews DJ. Basics of bone metabolism and osteoporosis in common pediatric neuromuscular disabilities. Eur J Paediatr Neurol. 2018;22(1):17-26. https://doi.org/10.1016/ j.ejpn.2017.08.001.

[11] Пырьева Е.А., Сорвачева Т.Н., Сафронова А.Н. Нутритивная поддержка в лечении детей с неврологической патологией // Вопросы детской диетологии. – 2016. – Т. 14. – № 1. – С. 47–53. [Pyreva EA, Sorvacheva TN, Safronova AN. Nutritive support in treatment of children with neurological pathology. Problems of pediatric nutritiology. 2016;14(1):47-53. (In Russ.)]. https://doi.org/10.20953/1727-5784-2016-1-47-53.

[12] Kilpinen-Loisa P, Pihko H, Vesander U, et al. Insufficient energy and nutrient intake in children with motor disability. Acta Paediatr. 2009;98(8):1329-1333. https://doi.org/10.1111/j.1651-2227.2009.01340.x.

[13] Unay B, Sarici SU, Vurucu S, et al. Evaluation of bone mineral density in children with cerebral palsy. Turk J Pediatr. 2003;45(1):11-14.

[14] Houlihan CM, Stevenson RD. Bone density in cerebral palsy. Phys Med Rehabil Clin N Am. 2009;20(3):493-508. https://doi.org/10.1016/j.pmr.2009.04.004.

[15] Henderson RC, Kairalla JA, Barrington JW, et al. Longitudinal changes in bone density in children and adolescents with moderate to severe cerebral palsy. J Pediatr. 2005;146(6):769-775. https://doi.org/10.1016/ j.jpeds.2005.02.024.

[16] Akhter N, Khan AA, Ayyub A. Motor impairment and skeletal mineralization in children with cerebral palsy. J Pak Med Assoc. 2017;67(2):200-203.

[17] Finbråten AK, Syversen U, Skranes J, et al. Bone mineral density and vitamin D status in ambulatory and non-ambulatory children with cerebral palsy. Osteoporos Int. 2015;26(1):141-150. https://doi.org/10.1007/s00198-014-2840-0.

[18] Ивашикина Т.М., Котова Т.Н., Омарова П.Ш., и др. Возрастная динамика уровня сывороточных костных маркеров у здоровых детей // Клиническая лабораторная диагностика. – 2010. – № 11. – С. 7–10. [Ivashikina TM, Kotova TN, Omarova PS, et al. Age-related changes in the level of serum bone markers in healthy children. Russian clinical laboratory diagnostics. 2010;(11):7-10. (In Russ.)]

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Kenis V.M., Bogdanova S.L., Prokopenko T.N., Sapogovskiy A.V., Kiseleva T.I.