Abstract
The purpose of this study was to determine factors contributing to the high incidence of fractures in patients with spastic quadriplegic cerebral palsy in residential care, and to assess the effect of vitamin D therapy.
Over a period of four years, 20 patients in a cohort of 88 had sustained 56 long bone fractures. We compared them to an age-matched group from the same cohort with no history of fractures. The mobility of patients, who spent their time indoors, was severely restricted in both groups.
There was radiological and biochemical evidence of rickets and osteomalacia in both groups, but the disease was more severe in the fracture group. There was a significant relationship between the number of fractures and the use of anticonvulsant therapy.
Administration of vitamin D (5 000 IU per day) to both the fracture and control group over three months resulted in a marked increase in mean serum calcium (p =0.01), and a dramatic decrease (p < 0.003) in mean alkaline phosphatase to a level just above normal. All non-ambulatory residents with cerebral palsy now receive a maintenance dose of 50 000 IU of calciferol a month. No further fractures have occurred since vitamin D administration.
We recommend vitamin D supplementation for all non-ambulatory children with cerebral palsy in residential care who do not get regular exposure to sunlight.
The abstracts were prepared by Professor M. B. E. Sweet. Correspondence should be addressed to him at The Department of Orthopaedic Surgery, Medical School, University of Witwatersrand, 7 York Road, Parktown, Johannesburg, 2193 South Africa
