{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T17:42:30Z","timestamp":1790185350632,"version":"4.1.0"},"reference-count":50,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2025,2,10]],"date-time":"2025-02-10T00:00:00Z","timestamp":1739145600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Developmental Grant from the Shriners Hospitals for Children","award":["72011-CAN-20"],"award-info":[{"award-number":["72011-CAN-20"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,4,21]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>Cerebral palsy (CP) is a non-progressive neurological syndrome resulting in abnormal muscle tone, movement, and posture. It is unclear whether ambulatory children with CP have deficits in bone quantity or quality. Furthermore, the relationship between abnormal muscle tone, altered function, and bone health remains largely unexplored. This observational study investigated bone mineral density (BMD) and microarchitecture in ambulatory children with spastic CP and associations of BMD with function, muscle spasticity, and gait. Children with spasticity in both lower limbs (n\u2009=\u200912) aged 3-8\u00a0years were recruited. Areal BMD was measured with dual energy x-ray absorptiometry (DXA) at the proximal femur and lateral distal femur and compared to normative data. High resolution peripheral quantitative computed tomography (HR-pQCT) was performed at the metaphyseal tibia and radius in a subset of participants (n\u00a0=\u20095) and compared to healthy children (n\u2009=\u20097). Gait pathology and cardiopulmonary function were investigated with the Gait Deviation Index, Edinburgh Visual Gait Score, and energy expenditure index. DXA areal BMD (aBMD) Z-scores at the lateral distal femur were within a normal range. However, the CP group\u2019s median aBMD Z-score at the proximal femur was \u22121.8 (IQR: \u22122.2, \u22121.2, p\u00a0=\u2009.03) indicating potential skeletal fragility. Strong correlations were found between gait pathology and DXA-based bone outcomes (correlation coefficient 0.62 [p\u00a0=\u2009.04] to 0.73 [p\u00a0=\u2009.01]) as well as energy expenditure index and DXA-based bone outcomes (correlation coefficient \u22120.63 [p\u00a0=\u2009.03] to \u22120.98 [p\u2009\u2264\u2009.001]). At the metaphyseal tibia, children with spastic CP had significant deficits in HR-pQCT-measured bone geometry and trabecular microarchitecture: 35% lower total area, 42% lower trabecular area, and 48% lower trabecular number than controls. HR-pQCT parameters were similar between groups at the metaphyseal radius. These differences in tibial metaphysis size and trabecular microarchitecture are similar to those observed in disuse and thus could be a result of abnormal biomechanics or low levels of physical activity.<\/jats:p>","DOI":"10.1093\/jbmr\/zjaf026","type":"journal-article","created":{"date-parts":[[2025,2,10]],"date-time":"2025-02-10T15:32:01Z","timestamp":1739201521000},"page":"511-521","source":"Crossref","is-referenced-by-count":7,"title":["Ambulatory children with spastic cerebral palsy have smaller bone area and deficits in trabecular microarchitecture"],"prefix":"10.1093","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9927-3372","authenticated-orcid":false,"given":"Elizabeth A","family":"Zimmermann","sequence":"first","affiliation":[{"name":"Faculty of Dental Medicine and Oral Health Sciences, McGill University , Montreal (QC) H3A 0C7 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,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-2753-4957","authenticated-orcid":false,"given":"Dominique","family":"Audet","sequence":"additional","affiliation":[{"name":"Department of Clinical Research, Shriners Hospitals for Children , Montreal (QC) H4A 0A9 ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rita","family":"Yap","sequence":"additional","affiliation":[{"name":"Department of Physiotherapy, Shriners Hospitals for Children , Montreal (QC) H4A 0A9 ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine","family":"Julien","sequence":"additional","affiliation":[{"name":"Research Center, Shriners Hospitals for Children , Montreal (QC) H4A 0A9 ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5638-976X","authenticated-orcid":false,"given":"Seyedmahdi","family":"Hosseinitabatabaei","sequence":"additional","affiliation":[{"name":"Faculty of Dental Medicine and Oral Health Sciences, McGill University , Montreal (QC) H3A 0C7 ,","place":["Canada"]},{"name":"Research Center, Shriners Hospitals for Children , Montreal (QC) H4A 0A9 ,","place":["Canada"]},{"name":"Department of Biomedical Engineering, McGill University , Montreal (QC) H3A 2B4 ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eliane","family":"Rioux Trottier","sequence":"additional","affiliation":[{"name":"Research Center, Shriners Hospitals for Children , Montreal (QC) H4A 0A9 ,","place":["Canada"]},{"name":"Department of Surgery, Centre Hospitalier Universitaire Sainte-Justine , Montreal (QC) H3T 1C5 ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2907-3580","authenticated-orcid":false,"given":"Bettina M","family":"Willie","sequence":"additional","affiliation":[{"name":"Faculty of Dental Medicine and Oral Health Sciences, McGill University , Montreal (QC) H3A 0C7 ,","place":["Canada"]},{"name":"Research Center, Shriners Hospitals for Children , Montreal (QC) H4A 0A9 ,","place":["Canada"]},{"name":"Department of Biomedical Engineering, McGill University , Montreal (QC) H3A 2B4 ,","place":["Canada"]},{"name":"Department of Pediatric Surgery, McGill University , Montreal (QC) H4A 3H9 ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8103-4795","authenticated-orcid":false,"given":"Alessandra","family":"Carriero","sequence":"additional","affiliation":[{"name":"Department of Biomedical Engineering, The City College of New York , New York (NY) 10031 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