Fracture Rates in Children with Cerebral Palsy: A Danish, Nationwide Register-Based Study

Abstract

Jakob Bie Granild-Jensen,1,2 Alma Becic Pedersen,2,3 Eskild Bendix Kristiansen,3 Bente Langdahl,2,4 Bjarne Møller-Madsen,2,5 Charlotte Søndergaard,6 Stense Farholt,7 Esben Thyssen Vestergaard,1,2 Gija Rackauskaite8 1Department of Child and Youth, Randers Regional Hospital, Randers, Denmark; 2Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; 3Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark; 4Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark; 5Department of Children’s Orthopedics, Aarhus University Hospital, Aarhus, Denmark; 6Department of Pediatrics and Adolescent Medicine, Gødstrup Regional Hospital, Gødstrup, Denmark; 7Centre for Rare Diseases - Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark; 8Department of Pediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, DenmarkCorrespondence: Jakob Bie Granild-Jensen, Department of Child and Youth, Randers Regional Hospital, Oestervangsvej 54, Randers, NE, 8930, Denmark, Email [email protected]: In children with cerebral palsy (CP), fracture rates have been reported to be higher than in the general population but age-specific fracture rates have not been directly compared and the effect of comorbid epilepsy needs elucidation. This impairs decision-making regarding bone health interventions.Aim: We aimed to establish the age-specific fracture rates in children with CP with and without epilepsy in Denmark.Materials and Methods: Data from Danish registers were combined to establish cohorts of children with and without CP born in Denmark from 1997 to 2007. Fracture rates were calculated for 1997– 2016.Results: We identified 1,451 children with CP and 787,159 without CP. Female/male fracture rates per 1,000 person-years were 23/27 with CP and 23/29 without CP. Male sex, epilepsy and anti-seizure medication, but not the diagnosis of CP or GMFCS-level, were associated with higher fracture rates. Relatively more lower extremity fractures occurred in non-ambulant children with CP.Interpretation/Conclusion: We found no increased fracture rates in children with CP when compared to peers; however, fracture locations suggested bone fragility in non-ambulant children. All children with epilepsy and on anti-seizure medication had increased fracture rates. We suggest bone health optimization in these groups.Keywords: fracture rate, cerebral palsy, children, Gross Motor Classification System, epilepsy, anti-seizure medication

Keywords

• fracture rate cerebral palsy children gross motor classification system epilepsy anti-seizure medication