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Bone. 2019 Aug;125:30-35. doi: 10.1016/j.bone.2019.05.007. Epub 2019 May 8.

Incidence of osteoarthritis, osteoporosis and inflammatory musculoskeletal diseases in adults with cerebral palsy: A population-based cohort study.

Author information

1
Institute of Environment, Health and Societies, Brunel University London, Kingston Lane, Uxbridge, UB8 3PH, United Kingdom. Electronic address: neil.oconnell@brunel.ac.uk.
2
Department of Psychological Sciences, Faculty of Health and Medical Sciences, University of Surrey, United Kingdom.
3
Department of Physical Medicine and Rehabilitation, University of Michigan Medicine, USA.
4
Department of Cardiology, Aberdeen Royal Infirmary, United Kingdom; Department of Interventional Cardiology, Hospital Clínico San Carlos, Spain.
5
School of Mathematical Sciences, Queen Mary University of London, United Kingdom.
6
Institute of Environment, Health and Societies, Brunel University London, Kingston Lane, Uxbridge, UB8 3PH, United Kingdom.
7
Institute of Environment, Health and Societies, Brunel University London, Kingston Lane, Uxbridge, UB8 3PH, United Kingdom; Department of Epidemiology and Public Health Medicine, Royal College of Surgeons in Ireland, Ireland.

Abstract

BACKGROUND:

People with cerebral palsy (CP) may be at increased risk of musculoskeletal conditions due to various factors including malnutrition and abnormal levels of skeletal loading. This study aimed to compare the incidence of osteoporosis, osteoarthritis and inflammatory musculoskeletal diseases between adults with and without CP.

METHODS:

A population based cohort study was conducted using data from the Clinical Practice Research Datalink collected between 1987 and 2015. Adults with CP were matched to adults without CP for age, sex and general practice. Cox models, stratified by matched set and adjusted for potential confounders, were fitted to compare the risk of osteoporosis, osteoarthritis and inflammatory musculoskeletal diseases.

RESULTS:

1705 adults with CP were matched to 5115 adults without CP. Adults with CP had an increased risk of osteoporosis in unadjusted (Hazard Ratio (HR) 3.67, 95% Confidence Interval (CI) 2.32 to 5.80, p < 0.001) and adjusted (HR 6.19, 95% CI 3.37 to 11.39, p < 0.001) analyses. No evidence of increased risk of inflammatory musculoskeletal diseases was observed in unadjusted or adjusted analyses. For osteoarthritis no evidence of increased risk was seen in the unadjusted analysis, but evidence of an increased risk was seen when the analysis was adjusted for alcohol consumption, smoking status, and mean yearly general practice (GP) visits (HR 1.54, 95% CI 1.17 to 2.02, p < 0.001).

CONCLUSIONS:

After accounting for potential confounding variables, we found that CP is associated with increased risk of osteoporosis and osteoarthritis. These findings provide the strongest epidemiological evidence to date for increased risk of osteoporosis and osteoarthritis in people with CP, and highlight need for clinical awareness of such conditions in this population.

KEYWORDS:

Cerebral palsy; Incidence; Inflammatory musculoskeletal diseases; Osteoarthritis; Osteoporosis

PMID:
31075418
DOI:
10.1016/j.bone.2019.05.007
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