Fracture threshold in the femur and tibia of people with spinal cord injury as determined by peripheral quantitative computed tomography

Eser, Prisca; Frotzler, Angela; Zehnder, Yvonne; Denoth, Jachen

doi:10.1016/j.apmr.2004.09.006

Cited by 113 publications

(90 citation statements)

References 23 publications

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“…However, bone loss at the distal tibia has been associated with prevalent fractures after SCI. 26 In summary, significant correlations were found between muscle strength and bone geometry/density in the lower limb of individuals with chronic SCI. The relationship was strongest at the distal tibia, and was not influenced by DOI.…”

Section: Discussionmentioning

confidence: 87%

An evaluation of the muscle-bone unit theory among individuals with chronic spinal cord injury

2011

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Study design: Cross-sectional observation. Objectives: To explore the association between muscle size and function, and indices of bone strength among a sample of adults with chronic spinal cord injury (SCI). Setting: Ontario, Canada. Methods: Sixty-five participants (n¼47 men) with chronic SCI (C1-T12 American Spinal Injury Association Impairment Scale (AIS) A-D) were recruited, mean ± s.d. age 49.4 ± 12.8 years and years post-injury 14.3 ± 10.7. Muscle cross-sectional area (CSA) and indices of bone strength at the distal tibia and tibia shaft were measured by peripheral quantitative computed tomography. Muscle CSA was multiplied by tibia length to obtain muscle-bending moment (MBM), a surrogate of torque. Plantar flexor components of the lower-extremity motor scores (pf-LEMS) were used as clinical measures of muscle function. Pearson's correlations (r) were used to determine the strength of relationships. Results: Correlations were found between MBM and indices of bone strength at the distal tibia and tibia shaft (r¼0.44-0.56), as well as between pf-LEMS and indices of bone strength at the distal tibia and tibia shaft (r¼0.37-0.71). pf-LEMS had a stronger association with bone variables at the distal tibia compared with MBM (r¼0.6 vs r¼0.4). All relationships between muscle and bone remained significant when controlling for the duration of injury.Conclusion: It appears that lower limb muscle size and function are more strongly correlated with bone strength indices at the distal tibia than at the tibia shaft among individuals with SCI. The relationships between muscle and bone are clinically important, as muscle CSA and strength (motor scores) are potentially amenable to rehabilitation intervention(s).

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Section: Discussionmentioning

confidence: 87%

An evaluation of the muscle-bone unit theory among individuals with chronic spinal cord injury

2011

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“…First, as related in the previous section, the maximal strains in a bone's loading milieu may trigger anabolism (in athletes, for instance) or catabolism (as in SCI). Support exists for this viewpoint at both ends of the loading continuum [83,131]. Other researchers, however, point out that low-intensity and usually imperceptible vibratory loads predominate bone's daily strain history [132].…”

Section: Three-dimensional Densitometric Techniques (Such As Periphermentioning

confidence: 99%

“…The BMD level at which fracture risk increases is not known with certainty. However, Eser and coauthors reported that fractures occurred in subjects with BMD less than 46 and 29 percent of non-SCI norms for the distal femur and distal tibia, respectively [83]. Up to 44 percent of reported fractures occur with minimal inciting trauma [85].…”

Section: Bone Adaptations To Scimentioning

confidence: 99%

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Muscle and bone plasticity after spinal cord injury: Review of adaptations to disuse and to electrical muscle stimulation

Dudley-Javoroski

Shields

2008

JRRD

156

139

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Abstract-The paralyzed musculoskeletal system retains a remarkable degree of plasticity after spinal cord injury (SCI). In response to reduced activity, muscle atrophies and shifts toward a fast-fatigable phenotype arising from numerous changes in histochemistry and metabolic enzymes. The loss of routine gravitational and muscular loads removes a critical stimulus for maintenance of bone mineral density (BMD), precipitating neurogenic osteoporosis in paralyzed limbs. The primary adaptations of bone to reduced use are demineralization of epiphyses and thinning of the diaphyseal cortical wall. Electrical stimulation of paralyzed muscle markedly reduces deleterious post-SCI adaptations. Recent studies demonstrate that physiological levels of electrically induced muscular loading hold promise for preventing post-SCI BMD decline. Rehabilitation specialists will be challenged to develop strategies to prevent or reverse musculoskeletal deterioration in anticipation of a future cure for SCI. Quantifying the precise dose of stress needed to efficiently induce a therapeutic effect on bone will be paramount to the advancement of rehabilitation strategies.

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“…BMC in the lower limbs negatively correlated with the DOP in the groups with paraplegia, but after investigating according to the NLOI, we found this correlation to be due to the strong correlation of group A's lower-limb BMC with DOP, meaning that the NLOI determines the extent of bone loss. SSI is an important validated biomechanical strength bone parameter because it is related to bone breaking force, an explanation of why people with chronic SCI are prone to bone fractures [23]. A recent publication found different DOP until steady state for different parameter and scan sites [24].…”

Section: Figurementioning

confidence: 99%

Influence of neurological level of injury in bones, muscles, and fat in paraplegia

Dionyssiotis¹,

Lyritis²,

Παπαϊωάννου³

et al. 2009

JRRD

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Abstract-To investigate the influence of the neurological level of injury in bone mineral content (BMC) and mechanical properties, lean mass (LM), and fat mass (FM) among paraplegics with a similar duration of paralysis (DOP), we separated 30 paraplegics into group A (15 men, high-level paraplegia) and group B (15 men, low-level paraplegia) and compared them with group C (33 men, nondisabled). In all subjects, we measured stress-strain index (SSI) at 14% (SSI 2 ) and 38% (SSI 3 ) of the tibia length and the difference between them using peripheral quantitative computed tomography (XCT 3000 [Stratec Medizintechnik, Pforzheim, Germany]) and lower-limb BMC, LM, and FM (g) using whole-body dual-energy X-ray absorptiometry Inc; Fort Atkinson, Wisconsin]). Bone strength parameters, BMC, and LM were statistically decreased, but we found no difference in paraplegic FM compared with group C. We found a correlation between the DOP and the difference between SSI 3 and SSI 2 in group B (r = 0.53, p = 0.03 and r = 0.5, p = 0.04, respectively). We correlated DOP with FM in group A's lower limbs (r = 0.5, p = 0.05). Because of the nonsignificant DOP, the groups with paraplegia act differently in tibia mechanical properties and lower-limb body composition.

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Fracture threshold in the femur and tibia of people with spinal cord injury as determined by peripheral quantitative computed tomography

Cited by 113 publications

References 23 publications

An evaluation of the muscle-bone unit theory among individuals with chronic spinal cord injury

An evaluation of the muscle-bone unit theory among individuals with chronic spinal cord injury

Muscle and bone plasticity after spinal cord injury: Review of adaptations to disuse and to electrical muscle stimulation

Influence of neurological level of injury in bones, muscles, and fat in paraplegia

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