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Cerebral palsy confers greater risk for all-cause fracture

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February 19, 2019

Adults with cerebral palsy are twice as likely to sustain a fracture of any type than the overall population, even after accounting for their higher prevalence of cardiometabolic diseases and osteoporosis, according to findings published in the Journal of Bone and Mineral Research.

Daniel G. Whitney

“This study shows for the first time in a large sample that adults with cerebral palsy have increased fracture prevalence compared with the general population,” Daniel G. Whitney, PhD, a postdoctoral research fellow in the department of physical medicine and rehabilitation at the University of Michigan, told Endocrine Today. “Importantly, the sample with cerebral palsy in this study is likely a higher-functioning segment of the cerebral palsy population, and thus underestimating the true extent of the problem.”

In a cross-sectional study, Whitney and colleagues analyzed data from 5,555 adults with cerebral palsy (47.9% women; mean age, 42 years) and 5.5 million adults without (53.9% women; 53.5% white; mean age, 44 years), using beneficiary data from Optum Clinformatics Data Mart, a national claims database of beneficiaries from a single private payer. Researchers identified both osteoporotic pathologic fractures and any type of fracture of the head/neck, thoracic, lumbar/pelvic, upper extremity and lower extremity regions, and compared fracture prevalence between groups.

In the cerebral palsy group, 37.4% had hypertension or other cardiovascular disease, 12.4% had type 2 diabetes and 5.5% had osteoporosis. In the general population group, 25.6% had hypertension or other CVD, 10.1% had type 2 diabetes and 1.3% had osteoporosis.

Researchers found that adults with cerebral palsy had a higher prevalence of all-cause fracture vs. the overall population (6.3% vs. 2.7%), as well as a higher prevalence in all fracture subgroups (P < .01 for all).

In models adjusting for sociodemographic and socioeconomic variables, the adults with cerebral palsy were more likely to sustain a fracture vs. those without the condition (OR = 2.5; 95% CI, 2.2-2.7). That risk decreased after further adjusting for cardiometabolic diseases and osteoporosis but Was still higher for adults with cerebral palsy (OR = 2; 95% CI, 1.8-2.2), according to researchers. In sensitivity analyses, they found that adjusting for race did not change the findings.

“Individuals with cerebral palsy are predisposed to inadequate development of muscle and bone throughout growth and development and have poor preservation of musculoskeletal health and function throughout their adult years,” Whitney said. “This musculoskeletal phenotype increases fracture risk throughout the life span for this population. Fracture is a high-burden condition in terms of health care resource utilization, development of new morbidities, predictor of early mortality and overall poor quality of life.”

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Whitney said health services research is needed to identify predictors of fracture, complications associated with fracture and burdens after fracture, such as the development of new or worsening morbidities, mortality and the economic strain.

“Basic and translational research is needed to identify biological aspects of poor musculoskeletal development,” Whitney said. “Intervention research is needed to develop effective strategies to maximize musculoskeletal development, preservation and function throughout the life span.” – by Regina Schaffer

For more information:

Daniel G. Whitney, PhD, can be reached at 325 E. Eisenhower Parkway, Ann Arbor, MI 48108; email: dgwhit@umich.edu.

Disclosures: The authors report no relevant financial disclosures.

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