{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,7]],"date-time":"2026-11-07T19:35:56Z","timestamp":1794080156886,"version":"4.8.0"},"reference-count":37,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2025,7,7]],"date-time":"2025-07-07T00:00:00Z","timestamp":1751846400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Background\/Objectives: Cerebral palsy (CP) is the most common cause of neurological disability in children and is frequently associated with low bone mineral density (BMD) and increased risk of fractures. This study aimed to assess BMD in children with CP, compare it with normative standards, and explore potential associations with anthropometric parameters and the clinical characteristics of children with CP. Methods: Thirty-six children with CP aging 6\u201315 years from both sexes with varying levels of Gross Motor Functional Classification System (GMFCS) and spasticity were evaluated. Areal BMD and Z-scores (total and subtotal) were measured using dual-energy X-ray absorptiometry (DXA). Regression analysis identified predictors of BMD. Results: Children with GMFCS levels III\u2013V had significantly lower total and subtotal Z-scores compared to those with levels I\u2013II (p = 0.001 and p = 0.02, respectively). Total Z-score was significantly predicted by weight (\u03b2 = 1.02, p = 0.002), height (\u03b2 = \u22120.72, p = 0.02), and sedentary time (\u03b2 = \u22120.47, p = 0.005). \u201cNo walking\u201d was the only significant predictor for subtotal Z-score (\u03b2 = \u22120.50, p = 0.004). Conclusions: Children with moderate to severe CP exhibited significantly lower BMD, particularly those with limited ambulation and higher spasticity levels. These findings underscore the importance of early screening and targeted interventions to optimize bone health in this population.<\/jats:p>","DOI":"10.3390\/children12070894","type":"journal-article","created":{"date-parts":[[2025,7,7]],"date-time":"2025-07-07T11:19:27Z","timestamp":1751887167000},"page":"894","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Bone Mineral Density in Children with Cerebral Palsy: Associations with Anthropometric and Clinical Characteristics\u2014A Cross-Sectional Study"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-3191-5931","authenticated-orcid":false,"given":"Aqeelah Abdulelah","family":"Aljishi","sequence":"first","affiliation":[{"name":"Alahsa Health Cluster, Ministry of Health, Hofuf 36421, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4530-7084","authenticated-orcid":false,"given":"Mohammed A.","family":"Al-Omari","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, College of Medicine, Imam Abdulrahman Bin Faisal University, King Fahad Hospital of the University, Al-Khobar 31952, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7436-7118","authenticated-orcid":false,"given":"Ayat H.","family":"Al Safar","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, College of Medicine, Imam Abdulrahman Bin Faisal University, King Fahad Hospital of the University, Al-Khobar 31952, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shahad A.","family":"AlHazzaa","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, College of Medicine, Imam Abdulrahman Bin Faisal University, King Fahad Hospital of the University, Al-Khobar 31952, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5723-1147","authenticated-orcid":false,"given":"Alaa I.","family":"Ibrahim","sequence":"additional","affiliation":[{"name":"Department of Physical Therapy, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam 31451, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,7,7]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1006","DOI":"10.1007\/s12098-017-2475-1","article-title":"Cerebral Palsy: An Overview","volume":"85","author":"Gulati","year":"2018","journal-title":"Indian J. Pediatr."},{"key":"ref_2","first-page":"91","article-title":"Cerebral Palsy: An Overview","volume":"73","author":"Krigger","year":"2006","journal-title":"Am. Fam. Physician"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2392","DOI":"10.1080\/09638288.2018.1470261","article-title":"Low Bone Mineral Density in Ambulatory Persons with Cerebral Palsy? A Systematic Review","volume":"41","author":"Huisstede","year":"2019","journal-title":"Disabil. Rehabil."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"184","DOI":"10.1136\/practneurol-2015-001184","article-title":"Cerebral Palsy","volume":"16","author":"Wimalasundera","year":"2016","journal-title":"Pract. Neurol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1016\/j.ocl.2014.03.003","article-title":"Assessment and Treatment of Children with Cerebral Palsy","volume":"45","author":"Chan","year":"2014","journal-title":"Orthop. Clin. N. Am."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Nurkovi\u0107, J.S., Petkovi\u0107, P., Tiosavljevi\u0107, D., and Vojinovi\u0107, R. (2020). Measurement of Bone Mineral Density in Children with Cerebral Palsy from an Ethical Issue to a Diagnostic Necessity. BioMed Res. Int., 2020.","DOI":"10.1155\/2020\/7282946"},{"key":"ref_7","first-page":"154","article-title":"Perspective: Cerebral Palsy as a Model of Bone Development in the Absence of Postnatal Mechanical Factors","volume":"6","author":"Ward","year":"2006","journal-title":"J. Musculoskelet. Neuronal Interact."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"e5","DOI":"10.1542\/peds.110.1.e5","article-title":"Bone Density and Metabolism in Children and Adolescents with Moderate to Severe Cerebral Palsy","volume":"110","author":"Henderson","year":"2002","journal-title":"Pediatrics"},{"key":"ref_9","first-page":"45","article-title":"Review of Fractures and Low Bone Mass in Children with Cerebral Palsy","volume":"16","year":"2012","journal-title":"J. Orthop. Trauma Rehabil."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"232","DOI":"10.1097\/01202412-199605040-00003","article-title":"Pathological Fractures in Patients with Cerebral Palsy","volume":"5","author":"Brunner","year":"1996","journal-title":"J. Pediatr. Orthop. B"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1097\/PEP.0000000000000878","article-title":"Characteristics of interventions to improve bone health in children with cerebral palsy: A systematic review","volume":"34","author":"Liquori","year":"2022","journal-title":"Pediatr. Phys. Ther."},{"key":"ref_12","first-page":"e202310251","article-title":"Effectiveness of assisted standing on bone mineral density in children with cerebral palsy: A systematic review","volume":"122","year":"2024","journal-title":"Arch. Argent. Pediatr."},{"key":"ref_13","first-page":"316","article-title":"Spinal Bone Mineral Density, IGF-1 and IGFBP-3 in Children with Cerebral Palsy","volume":"68","author":"Ali","year":"2007","journal-title":"Horm. Res."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1007\/s11914-014-0224-1","article-title":"Fractures in Children with Cerebral Palsy","volume":"12","author":"Mughal","year":"2014","journal-title":"Curr. Osteoporos. Rep."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1016\/j.jocd.2014.01.005","article-title":"Bone Health in Children and Adolescents with Chronic Diseases That May Affect the Skeleton: The 2013 ISCD Pediatric Official Positions","volume":"17","author":"Bianchi","year":"2014","journal-title":"J. Clin. Densitom."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"918","DOI":"10.1111\/dmcn.13196","article-title":"Informing Evidence-Based Clinical Practice Guidelines for Children with Cerebral Palsy at Risk of Osteoporosis: An Update","volume":"58","author":"Ozel","year":"2016","journal-title":"Dev. Med. Child. Neurol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"959","DOI":"10.1177\/0883073809332401","article-title":"Evidence-Based Review of Bone Strength in Children and Youth with Cerebral Palsy","volume":"24","author":"Cohen","year":"2009","journal-title":"J. Child. Neurol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1016\/S1043-2760(00)00336-2","article-title":"Acquisition of Optimal Bone Mass in Childhood and Adolescence","volume":"12","author":"Bachrach","year":"2001","journal-title":"Trends Endocrinol. Metab."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1007\/s11154-005-6186-y","article-title":"Bone Mineral Accrual and Low Bone Mass: A Pediatric Perspective","volume":"6","author":"Gelfand","year":"2005","journal-title":"Rev. Endocr. Metab. Disord."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"974","DOI":"10.1093\/ptj\/80.10.974","article-title":"Validation of a Model of Gross Motor Function for Children with Cerebral Palsy","volume":"80","author":"Palisano","year":"2000","journal-title":"Phys. Ther."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"206","DOI":"10.1093\/ptj\/67.2.206","article-title":"Interrater Reliability of a Modified Ashworth Scale of Muscle Spasticity","volume":"67","author":"Bohannon","year":"1987","journal-title":"Phys. Ther."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1186\/s12984-019-0499-7","article-title":"Actigraph Assessment for Measuring Upper Limb Activity in Unilateral Cerebral Palsy","volume":"16","author":"Beani","year":"2019","journal-title":"J. Neuroeng. Rehabil."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"150","DOI":"10.1038\/oby.2002.24","article-title":"Validation and Calibration of Physical Activity Monitors in Children","volume":"10","author":"Puyau","year":"2002","journal-title":"Obes. Res."},{"key":"ref_24","first-page":"143","article-title":"Bone Health in Cerebral Palsy: Who\u2019s at Risk and What to Do about It?","volume":"7","author":"Houlihan","year":"2014","journal-title":"J. Pediatr. Rehabil. Med."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1007\/s11657-020-00740-5","article-title":"Calcium Intake in Colombia: Are We Still in Deficit?","volume":"15","author":"Coy","year":"2020","journal-title":"Arch. Osteoporos."},{"key":"ref_26","first-page":"200","article-title":"Motor Impairment and Skeletal Mineralization in Children with Cerebral Palsy","volume":"67","author":"Akhter","year":"2017","journal-title":"J. Pak. Med. Assoc."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1007\/s11657-018-0434-8","article-title":"Bone Mineral Density and Nutritional Status in Children with Quadriplegic Cerebral Palsy","volume":"13","year":"2018","journal-title":"Arch. Osteoporos."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1007\/s11657-018-0531-8","article-title":"Individualized Evaluation of Lumbar Bone Mineral Density in Children with Cerebral Palsy","volume":"13","author":"Duran","year":"2018","journal-title":"Arch. Osteoporos."},{"key":"ref_29","first-page":"334","article-title":"Body Composition in Nutritionally Adequate Ambulatory and Non-Ambulatory Children with Cerebral Palsy and a Healthy Reference Group","volume":"42","author":"Chad","year":"2000","journal-title":"Dev. Med. Child. Neurol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1007\/s00198-014-2840-0","article-title":"Bone Mineral Density and Vitamin D Status in Ambulatory and Non-Ambulatory Children with Cerebral Palsy","volume":"26","author":"Syversen","year":"2015","journal-title":"Osteoporos. Int."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"37S","DOI":"10.1016\/8756-3282(95)00378-9","article-title":"Using Functional Loading to Influence Bone Mass and Architecture: Objectives, Mechanisms, and Relationship with Estrogen of the Mechanically Adaptive Process in Bone","volume":"18","author":"Lanyon","year":"1996","journal-title":"Bone"},{"key":"ref_32","first-page":"11","article-title":"Evaluation of Bone Mineral Density in Children with Cerebral Palsy","volume":"45","author":"Unay","year":"2003","journal-title":"Turk. J. Pediatr."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1671","DOI":"10.2106\/00004623-199511000-00005","article-title":"Bone-Mineral Density in Children and Adolescents Who Have Spastic Cerebral Palsy","volume":"77","author":"Henderson","year":"1995","journal-title":"J. Bone Jt. Surg. Am."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"735","DOI":"10.1148\/radiology.179.3.2027984","article-title":"Bone Mass in Healthy Children: Measurement with Quantitative DXA","volume":"179","author":"Southard","year":"1991","journal-title":"Radiology"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"715","DOI":"10.1007\/s00198-011-1581-6","article-title":"Relationships of Muscle Strength and Bone Mineral Density in Ambulatory Children with Cerebral Palsy","volume":"23","author":"Chen","year":"2012","journal-title":"Osteoporos. Int."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1016\/j.jped.2021.07.005","article-title":"Physical Activity, Sedentary Time and Nutritional Status in Brazilian Children with Cerebral Palsy","volume":"98","author":"Tassitano","year":"2022","journal-title":"J. Pediatr. (Rio J)"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"773","DOI":"10.1111\/j.1469-8749.2009.03384.x","article-title":"Epidemiology of Low Bone Mineral Density and Fractures in Children with Severe Cerebral Palsy: A Systematic Review","volume":"51","author":"Mergler","year":"2009","journal-title":"Dev. Med. Child. Neurol."}],"container-title":["Children"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9067\/12\/7\/894\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:05:48Z","timestamp":1760033148000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9067\/12\/7\/894"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,7]]},"references-count":37,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2025,7]]}},"alternative-id":["children12070894"],"URL":"https:\/\/doi.org\/10.3390\/children12070894","relation":{},"ISSN":["2227-9067"],"issn-type":[{"value":"2227-9067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,7]]}}}