Theme: Prevent bone fractures caused by osteoporosis

Thesis statement : . On this article we will talk about 3 simple things we can do as a
caregiver at home to prevent osteoporosis caused by low BMD that can leads to low-
trauma fractures: controlling vitamin D, calcium, and bone minerals intake; giving
simple weight bearing exercise; and providing protection at home.

Outlining procces

1. Controlling vitamin D, calcium and bone minerals intake

a. Importance of vitamin D, calcium, and bone minerals intake
b. The food source of vitamin D and calcium

2. Weight-bearing exercise
a. Prone position
b. Kneeling
c. Standing position

3. Providing protection at home

a. Using modality
b. Using safety tools
 Prevent Bone Fractures in CP Children

Children with Cerebral Palsy (CP) have some problems with their developmental as
follow as: gastrointestinal reflux, aspiration syndromes, respiratory infection, seizures, and
contractures. In the same way, they are prone to suffer low-trauma fracture because of
osteoporosis caused by low bone mineral density (BMD). According to the Journal of
Developmental Medicine and Child Neurology low BMD is found in more than 50% of patients
with variety disabilities, including CP. The incidence of fractures in cerebral palsy children has
been reported up to 9,7 percent per year in Korean base on LWW Journal. This condition happen
because of several factors such as poor nutrition, medication, and decreased weight bearing-bone
loading- because of functional disabilities. But, low BMD can be prevented by changing some of
child habitual. On this article we will talk about 3 simple things we can do as a caregiver at home
to prevent osteoporosis caused by low BMD that can leads to low-trauma fractures: controlling
vitamin D, calcium, and bone minerals intake; giving simple weight bearing exercise; and
providing protection at home.

In the first place, the caregiver should pay attention and control the vitamin D, calcium,
and bone minerals intake. Get enough of vitamin D, calcium, and bone minerals intake are
important for kids with CP. In fact, supplementation vitamin D increased bone mineral content
and density. In the same way, calcium supplementation determines an increase in bone mass.
Based on research, giving vitamin D and calcium for 9 months had increases to BMD level of
CP children. If the CP kids doesn’t get proper vitamin D, calcium, and bone minerals
consumption, it will lead to deficiency. The deficiency can cause various effect to the kids.
Deficiency of vitamin D can cause the following : Structural and bone minerals loss,
malformation of bones, rickets, and osteoporosis. Deficiency of calcium can cause some effect
such as bone weakness, bone fractures, osteoporosis, problems with proper blood clotting, and
delays in children’s growth and development. There are several food that contains rich of
vitamin D, calcium, and bone minerals content. Vitamin D can be found in salmon, tuna, fish
liver oil, and fortified products like milk, orange juice, and cereal. Moreover, the best sources of
calcium are milk, yogurt, and cheese. Other important minerals for bone health include
magnesium, phosphorus, copper, zinc, and manganese. These are needed in small amounts and
are readily available in beans, vegetables, and other foods. If you can make sure nutrition from
the diet is proper now you can jump to the next step, exercise.

Beside nutrition, weight bearing exercise also one of the factors which contribute to bone
strength. Children with CP severe and moderate usually immobilization, have low muscle
support and inactivity. This condition increase the possibility of osteoporosis and low-trauma
fractures. Furthermore, non-weight bearing situation can result long bone cortices become
thinner. Nevertheless weight-bearing exercise give bone loading can help to increase long bone Commented [i-[1]: Han, Eun Young. Choi, Jung Hwa. et
cortices become thicker and reduce the osteoporosis and fractures risk. Based on Eun Young Han all.The effect of weight bearing on bone mineral density and bone
growth in children with cerebral palsy : A randomized controlled
and team’s research in Korea, weight bearing exercise at least 2 hours a day and more than 5 day preliminary trial. Wolter Kluwer Health. Journal of Medicine. March
2017. Volume 96. Issue 10. p e5896.
in a week will increasing or maintaining BMD in children with CP. This exercise can you give
while you and your child are playing. The following 3 simple weight-bearing exercise you can
give to your child: prone, kneeling, and standing position. First positioned your child on prone
position, place a bolsters under your child chest and help them to support their body with their
forearm. This position goal’s is upper extremity bones. Second position is kneeling. Take a small
bench as high as his tummy. This bench help them to support their body and facilitate them to
place their hand playing some toys. Last position is standing positioned. This position maybe the
hardest position among all position. Besides nutrition and exercise, the safety of your child play
a role too.

Controlling nutrition by taking care of their diet and weight bearing exercise are useless if
you do not take care of your child safety. Providing protection at home become more important
because immobilization condition makes bones loss its density, any fall risk can leads to
fractures. Fractures prevention by taking care of your child safety can be done if you use some
modalities and providing pretection tools at home. You can use ankle foot orthose (AFO) as a
modality to help us. Using AFO Besides using modalities, other effort you could do is using
safety tools at the place which your child have a risk to fall. Use safety gates on stairs, and keep
them in safety place. As though lock windows or shield them with window guard so your child
can not fall out, Last, you have to take care carefully your child and as much safe physical
activity as possible.

On the whole, there are three important things you should stick on your mind to prevent
fractures in your child: nutrition, exercise, and protection. You should watch and care to what
your child consume. They need so much calcium, vitamin D, and bone minerals intake.
Deficiency of these minerals are the first line to open the door leads to osteoporosis which can
cause fractures in your child. Good food without exercise is useless. So, do not be lazy to do
exercise while playing. Make a playing-therapy plan at home with your physical therapy. If you
do these two things you are one step closer to say goodbye with osteoporosis but it all
meaningless if you do not watch your child safety. Be careful with your child activities do not
forget to use any modalities that will help you. Remember, it is like evil circle. If you forgot
about the nutrition but good in exercise and protection it will not reach our target to prevent
fractures caused by osteoporosis. Vice versa. Do these 3 simple things and your child far from
osteoporosis and fractures risk.

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Sources:

Christine Murray Houlihan, MD and Richard D. Stevenson, MD. Bone Density in Cerebral
Palsy. Phys Med Rehabili Clin N am. 2009 Aug : 20(3): 493-508
https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prli
nks&id=19643349

Dietary needs for children with cerebral palsy. http://kidshealth.org/en/parents/diet-cerebral-

palsy.html# (accessed at 29 November 2017).

Han, Eun Young. Choi, Jung Hwa. et all.The effect of weight bearing on bone mineral density
and bone growth in children with cerebral palsy : A randomized controlled preliminary trial.
Wolter Kluwer Health. Journal of Medicine. March 2017. Volume 96. Issue 10. p e5896.

Bianchi, Maria Luisa. How to Manage osteoporosis in children. Best Practice and Research
Clinical Rheumatology. Volume 19. Issue 6. December 2005. Pages 91-1005