Impact of Growth Factors and Bone Age on BMD in Children and Adolescents With Cerebral Palsy

AIM: Children with cerebral palsy (CP) have reduced bone mineral density (BMD) and increased risk of fragility fracture. Despite the critical role in skeletal development, no studies have examined insulin-like growth factor-1 (IGF-1) and insulin-like growth factor binding protein- 3 (IGFBP-3), and their association with BMD in children with CP when adjusted for bone age. This study assesses the relationship between IGF-1 and IGFBP-3 and BMD in children with CP while accounting for bone age adjustment. METHODS: Cross-sectional study, 81 children with CP GMFCS I-V, aged 2-17 years (55.6% males), underwent clinical examination, DXA scan, blood sampling and bone age assessment. Regression analysis assessed associations between IGF-1, IGFBP-3 and BMD. RESULTS: Bone age was 0.64 years lower than chronological age (p < 0.05). Adjusted for bone age, BMD showed a positive association with IGF-1 (p < 0.05) and IGFBP-3 (p < 0.05). BMD z-score negatively associated with CP severity (p < 0.05) and CP severity was negatively associated with IGF-1 (p < 0.5) and IGFBP-3 (p < 0.05). CONCLUSION: Children with CP had lower bone age than chronological age. BMD was positively associated with IGF-1 and IGFBP-3 adjusted for bone age. These findings are useful in growth hormone and osteoporosis treatment, such as Zoledronate, in CP.