Efficacy of low-intensity pulsed ultrasound in the prevention of osteoporosis following spinal cord injury

Warden, Stuart J.; Bennell, Kim L; Matthews, Bernadette; Brown, D. J.; McMeeken, Joan; Wark, John D.

doi:10.1016/s8756-3282(01)00599-3

Cited by 65 publications

(70 citation statements)

References 34 publications

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“…Pathological fracture risk in the SCI population has directed clinical attention towards fracture diagnostic thresholds, and avenues for osteoporosis prevention 22,30,31 and treatment. 7,12,13,23,32 Physical modalities (standing, FES cycle ergometry, 11-13 vibration 32,33 ) and pharmacological agents (amino-bisphosphonates [22][23][24] ) have been proposed as measures to slow the rapid loss of lower extremity bone after SCI.…”

Section: Discussionmentioning

confidence: 99%

Physiological effects of lower extremity functional electrical stimulation in early spinal cord injury: lack of efficacy to prevent bone loss

Clark

Jelbart

Rischbieth³

et al. 2006

Spinal Cord

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Study design: Controlled, repeat-measures study. Objectives: To determine if functional electrical stimulation (FES) can affect bone atrophy in early spinal cord injury (SCI), and the safety, tolerance and feasibility of this modality in bone loss remediation. Setting: Spinal Injuries Units, Royal Adelaide Hospital and Hampstead Rehabilitation Centre, South Australia. Methods: Patients with acute SCI (ASIA A-D) were allocated to FES (n ¼ 23, 2879 years, C4-T10, 13 Tetra) and control groups (CON, n ¼ 10, 31711 years, C5-T12, four Tetra). The intervention group received discontinuous FES to lower limb muscles (15 min sessions to each leg twice daily, over a 5-day week, for 5 months). Dual energy X-ray absorptiometry (DEXA) measured total body bone mineral density (tbBMD), hip, spine BMD and fat mass (FM) within 3 weeks, and 3 and 6 months postinjury. Results: FES and CON groups' tbBMD differed significantly at 3 months postinjury (Po0.01), but not thereafter. Other DEXA measures (hip, spine BMD, FM) did not differ between groups at any time. No adverse events were identified. Conclusion: Electrically stimulated muscle activation was elicited, and tetanic effects were reproducible; however, there were no convincing trends to suggest that FES can play a clinically relevant role in osteoporosis prevention (or subsequent fracture risk) in the recently injured patient. The lack of an osteogenic response in paralysed extremities to electrically evoked exercise during subacute and rehabilitation/recovery phases cannot be fully explained, and may warrant further evaluation.Spinal Cord (2007) 45, 78-85.

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Section: Discussionmentioning

confidence: 99%

Physiological effects of lower extremity functional electrical stimulation in early spinal cord injury: lack of efficacy to prevent bone loss

Clark

Jelbart

Rischbieth³

et al. 2006

Spinal Cord

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“…Twelveweek-old rats' bone cell activity may differ from that of older rats. Nevertheless, LIPUS does not prevent bone loss in growing rats after sciatic neurectomy either in skeletally mature humans after spinal cord injury, suggesting mature and young bones do not exhibit different responses to LIPUS [42,44]. Third, FAK and IRS-1 expression in intact bone subjected to habitual loading may be low; as such, immunoblotting was not sensitive enough to detect their expression in control groups.…”

Section: Discussionmentioning

confidence: 98%

“…Because LIPUS stimulates fracture repair but does not increase bone mineral density on growing bone or prevent osteoporosis after spinal cord injury and estrogen deprivation [21,35,41,42,44], we questioned whether LIPUS on intact bone would regulate FAK and ERK-1/2 expression and activation, which are proteins that act on mechanotransduction signaling and induce osteogenesis [36]. In addition, because mechanical loading acts Fig.…”

Section: Discussionmentioning

confidence: 99%

“…The failure of LIPUS to increase bone growth [35] may be explained by a noncumulative effect. In addition to the noncumulative effect of LIPUS, several observations may explain the failure of ultrasound to prevent bone loss in humans and animals deficient in estrogen or after neurectomy [21,41,42,44]: (1) the absence of the estrogen receptor a diminishes 70% of mechanically induced bone formation and completely Fig. 6A-B (A) Low-intensity pulsed ultrasound stimulation (LIPUS) increased insulin receptor substrate-1 (IRS-1) expression at 7 days.…”

Section: Discussionmentioning

confidence: 99%

“…LIPUS reportedly accelerates bone healing in animals [2,10,33] and humans [15,16,24] from the first week of stimulation onward [18,40]. Despite its pronounced effects during fracture repair, LIPUS does not increase bone mineral density or prevent bone loss of intact bone [21,35,41,42,44]. These observations suggest LIPUS cannot activate proteins that act in mechanotransduction signaling pathways or growth factor signaling pathways as both pathways lead to bone formation of intact bone.…”

Section: Introductionmentioning

confidence: 98%

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Low-intensity Ultrasound Increases FAK, ERK-1/2, and IRS-1 Expression of Intact Rat Bones in a Noncumulative Manner

Gusmão

Pauli

Saad

et al. 2010

Clinical Orthopaedics &Amp; Related Research

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Background Low-intensity pulsed ultrasound stimulation (LIPUS) reportedly increases osteogenesis in fracture models but fails in intact bone, suggesting LIPUS does not act on mechanotransduction and growth factor pathways of intact bone. Questions/Purposes We asked whether daily 20-minute LIPUS applied to intact tibias would act on bone proteins involved in mechanotransduction (focal adhesion kinase [FAK], and extracellular signal-regulated kinase-1/2 [ERK-1/2]), and growth factor signaling (insulin receptor substrate-1 [IRS-1]) pathways at 7, 14, and 21 days of treatment.Methods Immunoblotting was performed to detect FAK, ERK-1/2, and IRS-1 expression and activation from the stimulated intact tibias at 7, 14, and 21 days of daily 20-minute LIPUS. Results LIPUS increased FAK expression (at 7 days), ERK-1/2 (at 14 days), and IRS-1 (at 7 days), but expression decreased 7 days later, indicating a noncumulative effect of LIPUS. As only FAK expression was detected at 21 days, these observations suggest LIPUS influences nuclear reactions that may be modulated by a major cellular mechanism preferentially inhibiting IRS-1 expression and not FAK expression. Increased ERK-1/2 expression at 14 days suggests the differing mechanisms for promoting ERK-1/2, FAK, and IRS-1 syntheses. IRS-1 expression behaved similarly to FAK expression; therefore, LIPUS may modulate growth factor pathways. LIPUS increased sustained FAK and ERK-1/2 activation, but not IRS-1, suggesting sustained ERK-1/2 activation is not the result of mechanically induced growth factor activation. Conclusions LIPUS acts on mechanotransduction and growth factor pathways in intact bone in a noncumulative manner. Clinical relevance These data suggest LIPUS applied to intact bone acts on proteins involved in osteogenesis.

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Physical therapy interventions for the prevention of fractures after spinal cord injury

Gutiérrez¹,

Soto²,

Rada³

2013

Cochrane Database of Systematic Reviews

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Efficacy of low-intensity pulsed ultrasound in the prevention of osteoporosis following spinal cord injury

Cited by 65 publications

References 34 publications

Physiological effects of lower extremity functional electrical stimulation in early spinal cord injury: lack of efficacy to prevent bone loss

Physiological effects of lower extremity functional electrical stimulation in early spinal cord injury: lack of efficacy to prevent bone loss

Low-intensity Ultrasound Increases FAK, ERK-1/2, and IRS-1 Expression of Intact Rat Bones in a Noncumulative Manner

Physical therapy interventions for the prevention of fractures after spinal cord injury

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