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Bone Marrow Fat Physiology in Relation to Skeletal Metabolism and Cardiometabolic Disease Risk in Children With Cerebral Palsy

Whitney, Daniel G., PhD; Peterson, Mark D., PhD; Devlin, Maureen J., PhD; Caird, Michelle S., MD; Hurvitz, Edward A., MD; Modlesky, Christopher M., PhD

American Journal of Physical Medicine & Rehabilitation: December 2018 - Volume 97 - Issue 12 - p 911–919
doi: 10.1097/PHM.0000000000000981
Literature Review

Individuals with cerebral palsy exhibit neuromuscular complications and low physical activity levels. Adults with cerebral palsy exhibit a high prevalence of chronic diseases, which is associated with musculoskeletal deficits. Children with cerebral palsy have poor musculoskeletal accretion accompanied by excess bone marrow fat, which may lead to weaker bones. Mechanistic studies to determine the role of bone marrow fat on skeletal growth and maintenance and how it relates to systemic energy metabolism among individuals with cerebral palsy are lacking. In this review, we highlight the skeletal status in children with cerebral palsy and analyze the existing literature on the interactions among bone marrow fat, skeletal health, and cardiometabolic disease risk in the general population. Clinically vital questions are proposed, including the following: (1) Is the bone marrow fat in children with cerebral palsy metabolically distinct from typically developing children in terms of its lipid and inflammatory composition? (2) Does the bone marrow fat suppress skeletal acquisition? (3) Or, does it accelerate chronic disease development in children with cerebral palsy? (4) If so, what are the mechanisms? In conclusion, although inadequate mechanical loading may initiate poor skeletal development, subsequent expansion of bone marrow fat may further impede skeletal acquisition and increase cardiometabolic disease risk in those with cerebral palsy.

From the Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, Michigan (DGW, MDP, EAH); Department of Anthropology, University of Michigan, Ann Arbor, Michigan (MJD); Department of Orthopedic Surgery, Michigan Medicine, University of Michigan, Ann Arbor, Michigan (MSC); and Department of Kinesiology, University of Georgia, Athens, Georgia (CMM).

All correspondence should be addressed to: Daniel G. Whitney, PhD, Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI.

There has been no previous presentation of this work.

DGW is supported by the University of Michigan Advanced Rehabilitation Research Training Program in Community Living and Participation from the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR) (90AR5020-0200). MDP is funded by the National Institutes of Health (NIH) (1KO1 HD074706) and NIDILRR (90IF0102-01). CMM is funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development and the NIH (R01 HD090126).

Financial disclosure statements have been obtained, and no conflicts of interest have been reported by the authors or by any individuals in control of the content of this article.

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