Bone mineral density in upper and lower extremities during 12 months after spinal cord injury measured by peripheral quantitative computed tomography

Abstract

Objective: To evaluate the loss of trabecular and cortical bone mineral density in radius, ulna and tibia of spinal cord injured persons with di€erent levels of neurologic lesion after 6, 12 and 24 months of spinal cord injury (SCI). Design: Prospective study in a Paraplegic Centre of the University Hospital Balgrist, Zurich. Subjects and methods: Twenty-nine patients (27 males, two females) were examined by the highly precise peripheral quantitative computed tomography (pQCT) soon after injury and subsequently at 6, 12 and in some cases 24 months after SCI. Using analysis of the bone mineral density (BMD), various degrees of trabecular and cortical bone loss were recognised. A rehabilitation program was started as soon as possible (1 ± 4 weeks) after SCI. The in¯uence of the level of neurological lesion was determined by analysis of variance (ANOVA). Spasticity was assessed by the Ashworth Scale. Results: The trabecular bone mineral density of radius and ulna was signi®cantly reduced in subjects with tetraplegia 6 months (radius 19% less, P50.01; ulna 6% less, P40.05) and 12 months after SCI (radius 28% less, P50.01; ulna 15% less, P50.05). The cortical bone density was signi®cantly reduced 12 months after SCI (radius 3% less, P50.05; ulna 4% less, P50.05). No changes in BMD of trabecular or cortical bone of radius and ulna were detected in subjects with paraplegia. The trabecular BMD of tibia was signi®cantly reduced 6 months (5% less, P50.05) and 12 months after SCI (15% less, P50.05) in all subjects with SCI. The cortical bone density of the tibia only was decreased after a year following SCI (7% less, P50.05). No signi®cant di€erence between both groups, subjects with paraplegia and subjects with tetraplegia was found for tibia cortical or trabecular BMD. There was no signi®cant in¯uence for the physical activity level or the degree of spasticity on bone mineral density in all subjects with SCI. Conclusions: Twelve months after SCI a signi®cant decrease of BMD was found in trabecular bone in radius and in tibia of subjects with tetraplegia. In subjects paraplegia, a decrease only in tibia BMD occurred. Intensity of physical activity did not signi®cantly in¯uence the loss of BMD in all subjects with para-and tetraplegia. However, in some subjects regular intensive loading exercise activity in early rehabilitation (tilt table, standing) can possibly attenuate the decrease of BMD of tibia. No in¯uence was found for the degree of spasticity on the bone loss in all subjects with SCI. Spinal Cord (2000) 38, 26 ± 32

Long-term changes in the tibia and radius bone mineral density following spinal cord injury

“…Subjects with paraplegia showed no loss in the upper extremity bone substance. 23 The results of the current study confirm these findings. Nine of the subjects under investigation in our study were paraplegic and did not show a loss in BMD in the upper extremity.…”

“…13 A detailed description of the examination protocol has been described elsewhere. 22,23 Two parameters were derived and calculated for a general characterisation of the measured bone:…”

Intensive exercise may preserve bone mass of the upper limbs in spinal cord injured males but does not retard demineralisation of the lower body

“…5,6 A signi®cant di erence in arm bone mass between tetraplegic and paraplegic SCI has been reported by others. 5,6,13,14,33 We did not ®nd any substantial di erence in arm BMC and BMD between our two SCI groups, nor were there di erences noted when each SCI group was compared with the control population. A contributing factor to our disparity with the aforementioned studies may have been the inability to detect any signi®cant di erences in arm bone mass between our SCI participants with incomplete and complete lesions.…”

Energy expenditure during walking with weight-bearing control (WBC) orthosis in thoracic level of paraplegic patients

“…To this end, those on the upper and left side of the figure can be It is well known that paraplegic patients have significantly reduced V O 2 peak values as a consequence of the reduction in the daily activity levels. 19 In addition, the isolation of the upright standing and walking should lead to various secondary disorders, for example, the decrement of the bone mineral density 20,21 and malfunction of the peripheral circulation in paralyzed areas. 22 Although there is little agreement of the effect on the above point, there is no doubt that some purposeful effects should be offered by orthotic gait.…”