Influence of gait analysis on decision-marketing for lower extremity surgery

Fracture incidence before and after pamidronate treatment in children with cerebral palsy


  1. 1. Department of Pediatrics;
  2. 2. Department of Research;
  3. 3. Department of Medical Imaging, AI DuPont Hospital for Children, Wilmington, DE, USA

Background: Children and adults with cerebral palsy (CP) are at increased risk for fracture, often with minimal trauma. Lack of weight bearing, poor nutritional intake, minimal sun exposure, and use of anticonvulsants contribute to the low bone mineral density described in this population. Furthermore, once a patient has experienced a fracture, there is an even higher chance of re-fracture. Fracture rate in children with CP has been reported to be between 4 and 5.6%, and for those who have already had one fracture, 7%. A variety of treatments are being used and studied in an attempt to improve bone density in children with CP, including use of bisphosphonates. The effect of bisphosphonates on the rate of fractures in children with CP has not been described.

Objectives: To examine the rate of fracture before and after pamidronate treatment in children with spastic quadriplegic CP.

Method: Fracture histories of 26 participants (13 males, 13 females) with spastic quadriplegic CP who received pamidronate were retrospectively reviewed. Fracture rate before treatment was started and up to 5 years after, was calculated using the person-years method. All participants received 5 cycles (3doses/cycle) of pamidronate every 3 to 4 months for a total of 15 doses. Pamidronate dosage was 1mg/kg (max35mg).

Results: Twenty-four participants sustained 88 fractures before treatment; two participants had no fracture before treatment. After treatment was initiated, 12 participants sustained 19 fractures (seven during treatment). Of the seven fractures that occurred during treatment, five occurred before the third cycle of pamidronate was given, i.e. within the first 6 months of treatment. After the last treatment, 12 fractures were sustained in six participants- four in one participant and two each in two participants. Pre-treatment fracture rate was 27.9% per year before treatment based on 88 fractures in 314.9 person-years. After treatment began, the fracture rate dropped to 10.2%  per year (19 fractures in 186.5 person-years) and to 8.1% per year (14 fractures in 173.5 person-years) 6 months after treatment began.

Conclusion: This sample represents a select group of non-ambulatory children with CP who had documented low bone density by dual-energy X-ray absorptiometry and most of whom (all but two) had sustained at least one non-traumatic fracture before treatment with pamidronate. This explains the higher rate of fracture than that reported in the general CP population. Treatment with pamidronate reduced the incidence and overall rate of fracture for this group.

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