Post-fracture pneumonia risk and association with health and survival outcomes for adults with cerebral palsy: A retrospective cohort study

Five-year risk of fracture and subsequent fractures among adults with cerebral palsy

“…Another main finding is that the number and rate of subsequent fragility fractures among young men (18–40 years old) with CP and middle-aged women (41–64 years old) with CP was similar to elderly (≥65 years old) without CP, and increased with older age for CP. Prior studies have found that adults with vs. without CP have higher post-fracture morbidity and mortality burdens even prior to reaching their elderly years ( Etter et al, 2020 ; Whitney et al, 2020a ; Whitney et al, 2020b ; Whitney et al, 2022a ), and that subsequent fractures can exacerbate costly health declines in elderly without CP ( Balasubramanian et al, 2019 ; Bliuc et al, 2009 ; Weaver et al, 2017 ). Taken together, widespread policy, public health, and clinical efforts are needed to improve fracture prevention at much younger ages for adults with CP as compared to the general population.…”

“…The differential risks by fracture site may be exacerbated in adults with CP. For example, the absolute rate of incident cardiorespiratory disease and all-cause mortality has been shown to be higher for fragility fractures at the vertebral column and hip as compared to other lower extremity sites for adults with CP (e.g., 1-year mortality rate per 100 person-years: 9.0, 10.3, and 4.4, respectively) ( Etter et al, 2020 ; Whitney et al, 2020a ; Whitney et al, 2020b ; Whitney et al, 2022a ). However, the relative rate in these outcomes comparing adults with vs. without CP was higher for fragility fractures of the lower extremities as compared to the vertebral column and hip (e.g., 1-year mortality adjusted hazard ratio [95 % CI]: 1.95 [1.28–2.97], 1.39 [1.02–1.89], and 1.21 [0.88–1.66], respectively).…”

“…For example, the prevalence of fracture at any site is up to 6.5 times higher for adults with vs. without CP of the same age and sex strata ( Whitney et al, 2021a ). Moreover, population-based studies have reported strong associations between fragility fractures with incident cardiorespiratory morbidity and all-cause mortality among adults with CP, and that the fracture-associated disease sequela was present for women and men with CP and prior to reaching their elderly years ( Etter et al, 2020 ; Whitney et al, 2020a ; Whitney et al, 2020b ; Whitney et al, 2022a ).…”

Post-Fracture Inpatient and Outpatient Physical/Occupational Therapy and Its Association with Survival among Adults with Cerebral Palsy

“…One possible mechanism for these findings is that PT/OT mitigates the decline in function following a fracture, which likely prevents or decelerates the progression of health declines associated with inactivity. Fragility fractures are associated with an increased risk of cardiorespiratory diseases [ 2 , 3 , 5 ], which in turn mediates [ 35 ] a portion of the excess fracture-related mortality [ 4 ] among adults with CP. In studies not focused on CP, post-fracture rehabilitation has been reported to mitigate the loss of function and risk of mortality [ 7 , 8 ].…”

“…Fractures represent a quadruple threat to adults with cerebral palsy (CP) as they are common, begin to accumulate early in life [ 1 ], associated with premature morbidity and mortality [ 2 , 3 , 4 , 5 ], and are economically costly [ 6 ]. Clinical rehabilitation, including physical and/or occupational therapy (PT/OT), may be effective at mitigating post-fracture health declines, but this has been seldom studied among adults with CP.…”