Musculoskeletal health among adults with cerebral palsy: A systematic review

This systematic review looked at bone and joint health in adults with cerebral palsy (CP). We searched for studies that (1) described the burden of bone and joint disorders among adults with CP, (2) investigated factors that might predict who is more at risk of these disorders, (3) investigated the effectiveness of protocols to monitor bone and joint health, and (4) investigated the effectiveness of interventions to manage osteoarthritis in adults with CP. We searched for studies in six databases that were published between 1990 and 2024. We found 44 studies. Adults with CP were more likely to develop musculoskeletal disorders such as osteoarthritis, osteoporosis, and fractures compared to adults without CP. The risk was about twice as high for developing osteoarthritis, 6 times for developing osteoporosis, and between 2 to 6 times for experiencing fractures. Women and people with greater mobility limitations (e.g. non-ambulatory individuals) have a higher risk of poor bone health. There is limited strong evidence on the best ways to monitor or treat these conditions, making care less consistent. These bone and joint disorders can start earlier in adulthood among people with CP and may lead to pain, reduced mobility, and falls. Pain, stiffness, or declining mobility should not be dismissed as ‘just part of CP’. They may be signs of treatable conditions. It is important to raise concerns with healthcare providers and ask about bone and joint health. Adults with CP should consider requesting screening or assessments (e.g. bone density scans), especially if they have risk factors like reduced mobility or a history of falls.