Evaluation of bone mineral loss in patients with chronic traumatic spinal cord injury in Iran

Abstract

Objectives: We described the associations between demographic and injury-related factors on bone mineral density (BMD) of the spine and the hip among adult patients with chronic spinal cord injury (SCI). Design: BMD in spinal and femoral bone sites were assessed. Multivariate analysis was performed to evaluate the relationship between anthropometric and injury-related factors with BMD. Serum level and amount of dietary intake of calcium, phosphor, and 25-hydroxy vitamin D were measured. Setting: A referral tertiary rehabilitation center in Iran. Participants: Patients with SCI who had no previous history of endocrine disorders and were not on specific medications entered the investigation. Those with non-traumatic SCI, pregnant, or with substance dependency were excluded as well. Interventions: No interventions were applied. Main study outcome measures: Dual X-ray absorptiometry was performed to estimate BMD. Body mass index was positively associated with higher femoral (P < 0.01, r = 0.56) and hip (P < 0.0001, r = 0.82) BMD only in female participants. The high prevalence of vitamin D deficiency (60%) was noticeable. Results: Older male patients revealed lower BMD only in spinal vertebrae (P < 0.02, r = −0.21). A significant higher BMD loss in lumbar vertebras in male patients with complete spinal cord lesion (P < 0.009) was detected. Spinal reduction of BMD was more severe when the level of injury was above T6 (P < 0.02). Conclusion: Along with the clarification of age, gender, post injury duration, and the other factors' effect on the BMD in the SCI patients, here we have also shown the noticeable prevalence of the 25-hydoxy vitamin D deficiency in these patients which needs attention.

Risk factors for the development of osteoporosis after spinal cord injury. A 12-month follow-up study

“…As a result 41 % of patients were supplemented with this vitamin after their initial evaluation at baseline, with no significant differences between groups (data not shown). Indeed, previous studies have reported a high incidence of vitamin D deficiency (60 %) in SCI patients indicating the need to evaluate and correct this deficiency [28]. Therefore, we cannot totally rule out a possible influence of this supplementation on our results.…”

Comparison of energy efficiency between Wearable Power-Assist Locomotor (WPAL) and two types of knee-ankle-foot orthoses with a medial single hip joint (MSH-KAFO)

“…The inability to walk and stand can lead to joint contractures, pressure injuries, accelerated osteoporosis, spasticity and shortened life expectancy. [1][2][3] To restore the gait of patients with paraplegia, different types of hip-knee-ankle-foot orthoses (HKAFOs) have been studied. Orthoses equipped with bilateralsided hip joints and hard pelvic supports have been widely used.…”

Diagnosis of male osteoporosis after severe lumbar trauma

“…Of course, the mild VD deficiency can also contribute to the suboptimal response. VD deficiency is highly prevalent [8] (including in cases with traumatic spinal injury [9]), frequently suboptimally replaced (due to either insufficient doses recommended or decreased compliance) and plays a major role in rehabilitation [9]. This case illustrates the difficulties sometimes raised in appreciating the exact impact of a traumatic event in a patients with severe underlying bone disease.…”

“…In addition to its causal role related to the VF, the traumatic injury might have acted also as an aggravating factor of slow response to bisphosphonates. Studies on men with spinal cord injuries proved that with severe posttraumatic neurological damage significant BMD loss is found at the level of the affected lumbar vertebrae [8]. Of course, the mild VD deficiency can also contribute to the suboptimal response.…”