According to the study, middle-aged men with cerebral palsy are more likely to experience fractures
Michigan Medicine researchers found that a subset of middle-aged men with cerebral palsy were up to 5.6 times more likely to fracture than men without the condition.
We’re not really sure why this is happening. It may be related to structural differences that occur during adolescent growth or greater bone mineral loss in earlier years in people with cerebral palsy compared to their peers. “
Edward A. Hurvitz, MD, professor and chairman of the Michigan Medicine Department of Physical Therapy and Rehabilitation
For a study published in BONE, the team looked at the timing and location of bone fractures in approximately 10 million people with and without cerebral palsy using statutory and private insurance claims from 2016. They found that people with disabilities had brittle bones who had a pose a high risk of breakage, but at different times over the lifespan compared to the general population.
“Knowing that critical stages of bone health are different in people with cerebral palsy is critical for clinicians to not miss windows to increase bone strength,” said Daniel Whitney, Ph.D., principal investigator and assistant professor of physics Medicine and Rehabilitation at Michigan Medicine.
A critical phase of bone health occurs when a person’s bones change rapidly. In the years of development they get bigger and stronger. They lose bone mineral density over time and can become weaker – this can happen in women during menopause. Doctors often use these critical periods as reference points for fracture prevention efforts and post-fracture health management.
The team looked at life-span fracture risk to see if the critical stages of bone health in the general population coincided with timing of fracture susceptibility for people with cerebral palsy.
The result? Well it’s complicated.
In addition to revealing the surprisingly increased risk of fractures in middle-aged men, researchers found that adolescence and young adulthood are particularly prone times to fracture for people with cerebral palsy, but in different ways for women and men.
The team found that both age and gender affect fracture risk at different times over the life span and developed new gender-specific critical phases in bone health for this population.
While this study positions clinical care to better align with the timing of the skeletal needs of people with cerebral palsy, it also raises a number of questions, Whitney said.
“Why do middle-aged men with cerebral palsy show such a drastically increased risk of fractures?” he said. “Do women with cerebral palsy experience a similar timing or effect of the transition into menopause on bone health? What happens to the bone biology and structure at the beginning of their lives that create the conditions for their premature and profound bone fragility?”
It’s well known that people with cerebral palsy are at higher risk of fractures, but this new study will change the way we think about fracture prevention, especially for adults, Hurvitz said.
“When we consider the high risk of chronic disease and premature mortality associated with fractures that we discovered in our previous work, fracture prevention is a critical aspect of their care for this population,” he said.
The data on the claims used for the study do not show the severity of the condition of patients with cerebral palsy, which the researchers found would have contributed to their understanding of bone fragility.
This study will allow doctors to be more proactive about fracture prevention and the next step is to understand exactly why these patients have different bone health compared to the general population, Whitney said.
“If we only have a screwdriver, any problem looks like a screw,” he said. “This study offers new insights into the extent and unique timing of bone fragility over the lifespan of people with cerebral palsy and expands our tools to find new ways to solve a long-standing problem.”
Michigan Medicine – University of Michigan
Whitney, DG, et al. (2021) Critical phases of bone health throughout the life span for people with cerebral palsy: Informing clinical guidelines for fracture prevention and monitoring. Bone. doi.org/10.1016/j.bone.2021.116009.