Bone Health Status in Individuals with Amyotrophic Lateral Sclerosis: A Cross-Sectional Study on the Role of the Trabecular Bone Score and Its Implications in Neurorehabilitation

Abstract

Background and Objectives: Osteoporosis is a metabolic skeletal disease resulting in low bone mass with increased bone fragility and susceptibility to fractures. May lead to rapid loss of bone mineral density (BMD) due to physical inactivity and reduced muscle contractions. Generally, the diagnosis of osteoporosis is made using dual X-ray absorptiometry (DXA), by measuring BMD and the trabecular bone score (TBS), which can be useful for detecting bone fragility and susceptibility to fractures. Therefore, the aim of this study was to investigate, using BMD and TBS, the bone health status in a sample of amyotrophic lateral sclerosis (ALS) inpatients attending neurorehabilitation. Materials and Methods: Thirty-nine patients were included in the study and underwent electrocardiogram and blood tests, including calcium and parathyroid hormone, as well as vitamin D dosage, and DXA. Results: We found that the TBS of patients with osteoporosis was lower than that of those ALS patients with osteopenia or normal bone status, both in the lumbar spine and femoral neck, although no statistical significance was reached. In addition, Spearman’s correlation coefficient indicated a moderate correlation between TBS and lumbar spine BMD (r = −0.34) and a mild correlation between TBS and femoral neck BMD (r = −0.28). Conclusions: This study confirmed the hypothesis that ALS patients may exhibit deteriorated bone health with lower bone density and focused on the possible role of the TBS in the multidisciplinary approach to ALS.

Amyotrophic lateral sclerosis and osteoporosis: a two-sample Mendelian randomization study

“…Subsequently, a significant decrease in cortical bone mass was detected in individuals with ALS (Yanagihara et al, 1984). Likewise, Morini et al (2023) found that patients with ALS (16 male and 22 female individuals) showed lower BMD. According to a recent cross-sectional study, ALS patients represented statistically significantly worse bone quality parameters (including T-score and BMD) compared with the control group matched in sex and age (Caplliure-Llopis et al, 2020).…”

“…Muscle strength continuously regulates the structure and function of the skeleton, so when ALS causes muscle dysfunction, the skeleton is compromised accordingly; likewise, compromised bone balance can, in turn, contribute to muscle degeneration, which further accelerates ALS progression (Zhou et al, 2015). Clinical studies have found that ALS patients are at increased risk of developing osteoporosis and related fractures because of abnormal energy metabolism, malnutrition, decreased limb flexibility, increased joint stiffness, and frequent falls (Fernando et al, 2019;Morini et al, 2023). According to multiple observational studies, there is a strong statistical correlation between ALS and osteoporosis, whereas it is difficult to state the exact nature of the relationship since these studies are observational (Joyce et al, 2012;Kelly et al, 2020;Sooragonda et al, 2021).…”

Bone involvement in the early stages of Parkinson’s disease: a case–control study

“…A cross-sectional study investigated the bone health in a cohort of patients with amyotrophic lateral sclerosis and reported degraded and partially degraded values in over 65% of the patients despite normal BMD values. 34…”

“…A crosssectional study investigated the bone health in a cohort of patients with amyotrophic lateral sclerosis and reported degraded and partially degraded values in over 65% of the patients despite normal BMD values. 34 The originality of this current study was that it investigated for the first time the bone quality of patients with early stage PD. As the current results show, the TBS scores in patients with PD were significantly different according to the physical performance status based on SPPB scores; with lower a TBS in the subgroup with a lower SPPB score despite them having a normal BMD value.…”