Smaller and thinner long bones in children and adolescents with cerebral palsy and other neuromotor impairments
Bibliographic record
Abstract
Introduction/Background Compromised bone and muscle health is a significant concern for children and youth with cerebral palsy (CP) and other non-progressive neuromotor impairments. Weak bones increase the incidence of fragility fractures and predispose individuals to lifelong problems, such as osteoporosis. Objectives This study quantified bone and muscle health in children and adolescents with CP and other neuromotor impairments across all five gross motor function classification system (GMFCS) levels. Methods Peripheral quantitative computed tomography (pQCT) scans of both tibiae were acquired at the 3%, 38%, and 66% of tibia length in 22 children and adolescents (4–17 years old) diagnosed with CP and “CP-like” neurodevelopmental conditions causing motor impairment. Age-, sex-, and ethnicity-matched Z-scores were generated in reference to a normative typically developing population for total bone mineral content (BMC), trabecular and cortical bone mineral density (Tb.BMD, Ct.BMD), cortical BMC (Ct.BMC), cortical area (Ct.Ar), cortical thickness (Ct.Th), periosteal and endosteal circumference, cortical section modulus (Z), and muscle cross-sectional area (MCSA). Results Tibial total BMC, Tb.BMD, Ct.BMC, Ct.Th, Ct.Ar, periosteal circumference, Z, and MCSA were significantly lower in children with CP and CP-like conditions compared to typically developing peers (median Z-scores ranged from -2.66 to -1.09; p = 0.019 to <0.001) and showed greater deficits in children and adolescents with lower levels of motor function than those with higher functional abilities (GMFCS I-II vs III-V; p = 0.042 to <0.001). Endosteal circumference was not different from zero (p = 0.756) but was smaller in children and adolescents with lower levels of motor function (p = 0.042). Ct.BMD did not differ compared to typically developing youth (p = 0.202) or between functional abilities (p = 0.168). Conclusions Results reveal that bone and muscle size, total and cortical content, and trabecular density are impaired in children with CP and CP-like conditions; however, cortical mineralization is not impaired. Therefore, the heightened risk of fragility fractures in children and adolescents with CP and CP-like conditions is likely due to smaller and thinner bone structure. Future investigation into bone microarchitecture is warranted.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".