Cortical bone deficit and fat infiltration of bone marrow and skeletal muscle in ambulatory children with mild spastic cerebral palsy
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Introduction Nonambulatory children with severe cerebral palsy (CP) have underdeveloped bone architecture, low bone strength and a high degree of fat infiltration in the lower extremity musculature. The present study aims to determine if such a profile exists in ambulatory children with mild CP and if excess fat infiltration extends into the bone marrow.Materials and methods Ambulatory children with mild spastic CP and typically developing children (4 to 11years; 12/group) were compared. Magnetic resonance imaging was used to estimate cortical bone, bone marrow and total bone volume and width, bone strength [i.e., section modulus (Z) and polar moment of inertia (J)], and bone marrow fat concentration in the midtibia, and muscle volume, intermuscular, subfascial, and subcutaneous adipose tissue (AT) volume and intramuscular fat concentration in the midleg. Accelerometer-based activity monitors worn on the ankle were used to assess physical activity.Results There were no group differences in age, height, body mass, body mass percentile, BMI, BMI percentile or tibia length, but children with CP had lower height percentile (19th vs. 50th percentile) and total physical activity counts (44%) than controls (both p<0.05). Children with CP also had lower cortical bone volume (30%), cortical bone width in the posterior (16%) and medial (32%) portions of the shaft, total bone width in the medial-lateral direction (15%), Z in the medial-lateral direction (34%), J (39%) and muscle volume (39%), and higher bone marrow fat concentration (82.1±1.8% vs. 80.5±1.9%), subfascial AT volume (3.3 fold) and intramuscular fat concentration (25.0±8.0% vs. 16.1±3.3%) than controls (all p<0.05). When tibia length was statistically controlled, all group differences in bone architecture, bone strength, muscle volume and fat infiltration estimates, except posterior cortical bone width, were still present (all p<0.05). Furthermore, a higher intermuscular AT volume in children with CP compared to controls emerged (p<0.05).Conclusions Ambulatory children with mild spastic CP exhibit an underdeveloped bone architecture and low bone strength in the midtibia and a greater infiltration of fat in the bone marrow and surrounding musculature compared to typically developing children. Whether the deficit in the musculoskeletal system of children with CP is associated with higher chronic disease risk and whether the deficit can be mitigated requires further investigation.
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Individuals with cerebral palsy have low levels of physical activity regardless of their level of motor impairment.
“Specifically, individuals with CP have low levels of physical activity regardless of the level of motor impairment.7”
From Mental Health Disorders and Physical Risk Factors in Children with Cerebral Palsy: A Cross-Sectional Study (2019) · cites this paper as [7]
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Self-citation
- Authors
- Whitney, D. G., Singh, H., Miller, F., Barbe, M. F., Slade, J. M., Pohlig, R. T., & Modlesky, C. M.
- Affiliations
- University of Delaware (US)
- Alfred I. duPont Hospital for Children (US)
- Temple University (US)
- Michigan State University (US)
- Corresponding author
- Modlesky, Christopher M.
- ORCID
- Venue
- Bone
- Publisher
- Elsevier BV
- Published
- 2017-01
- Volume
- 94
- Pages
- 90-97
- ISSN
- 1873-2763 (ISSN-L)
- 8756-3282
- PMC
- PMC5912954
- OpenAlex
- W2530376686
- Cited by
- 108
- References
- 46
- Citations by year
- 2026: 4 · 2025: 3 · 2024: 14 · 2023: 14 · 2022: 13 · 2021: 12 · 2020: 18 · 2019: 15 · 2018: 13 · 2017: 2
- FWCI
- 8.88
- Type
- journal article
- Language
- en
- Open access
- green
- europepmc.org
- Locations
- Bone (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- NIH (HD071397)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Cerebral Palsy and Movement Disorders
- Health Sciences › Medicine › Orthopedics and Sports Medicine › Bone health and osteoporosis research
- Health Sciences › Medicine › Neurology › Botulinum Toxin and Related Neurological Disorders
- Keywords
- spastic cerebral palsy, ambulatory children, intramuscular fat, tibia, bone strength, section modulus, polar moment of inertia, muscle volume, physical activity, bone structure, body fat distribution, bone mineral area, bone mineral density
- MeSH terms
- Cortical Bone, Adipose Tissue, Biomechanical Phenomena, Bone Marrow, Cerebral Palsy, Child, Child, Preschool, Female, Humans, Image Processing, Computer-Assisted, Magnetic Resonance Imaging, Male, Tibia, Case-Control Studies, Walking, Muscle, Skeletal, Adiposity
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