Musculoskeletal Health in Active Ambulatory Men with Cerebral Palsy and the Impact of Vitamin D

Abstract Purpose: 1) To determine the contribution of diet, time spent outdoors and habitual physical activity (PA) on vitamin D status in men with cerebral palsy (CP) compared to age matched controls (TDC) without neurological impairment. 2) To determine the role of vitamin D on musculoskeletal health, morphology and function in men with CP compared to TDC.Materials and methods: A cross-sectional comparison study where, twenty-four active, ambulant men with CP aged 21.0±1.4 years (Gross Motor Function Classification Score I-II) and 24 healthy TDC aged 25.3±3.1 years completed in vivo assessment of musculoskeletal health, including: Vastus Lateralis anatomical cross-sectional area (VL ACSA), isometric knee extension maximal voluntary contraction (KE iMVC), 10m-sprint, vertical jumps (VJ), radius and tibia bones T and Z scores. Assessments of vitamin D status through venous samples of serum 25-hydroxyvitamin D (25(OH)D) and parathyroid hormone, dietary vitamin D intake from food diary and total sun exposure via questionnaire were also taken. Results: Men with CP had 40.5% weaker KE iMVC, 23.7% smaller VL ACSA, 22.2% lower VJ, 14.6% lower KE iMVC/VL ACSA ratio, 22.4% lower KE iMVC/body mass (BM) ratio and 25.1% lower KE iMVC/lean body mass (LBM) ratio (all p<0.05). Radius T and Z scores were 1.75 and 1.57 standard deviations lower than TDC, respectively (p<0.05), whereas neither tibia T nor Z scores showed any difference compared to TDC (p>0.05). 25(OH)D was not different between groups, and 90.9% of men with CP and 91.7% of TDC had low 25(OH)D levels when compared to current UK recommendations. 25(OH)D was positively associated with KE iMVC/LBM ratio in men with CP (r = 0.500, p=0.020), but not in TDC (r = 0.281, p=0.104).Conclusion: Musculoskeletal outcomes in men with CP were lower than TDC and despite there being no difference in levels of 25(OH)D between the groups, 25 (OH)D was associated with strength (KE iMVC/LBM) in the CP group, but not TDC. The findings suggest a greater sensitivity to low vitamin D in men with CP with regards to bone and muscle content and functional outcomes.