Sporting activity does not fully prevent bone demineralization at the impaired hip in athletes with amputation

Abstract

There is lack of information about bone mineralization at the lumbar spine and bilateral hips of athletes with unilateral lower limb amputation. The present study assessed for the first time the areal bone mineral density at the lumbar spine and at the hip of the able and impaired leg by means of Dual-Energy X-Ray Absorptiometry using a large sample (N = 40) of male athletes. Results showed that bone demineralization in athletes with unilateral lower limb amputation is found at the impaired hip but not at the lumbar spine and may therefore be site-specific. The extent of hip demineralization was influenced by the level of amputation, with about 80% of athletes with above knee amputation and 10% of athletes with below knee amputation showing areal bone mineral density below the expected range for age. Nevertheless, a reduced percentage of fat mass and a lower fat-to-lean mass ratio in the residual impaired leg as well as a greater amount of weekly training was positively associated with bone mineralization at the impaired hip (partial correlation coefficients = 0.377–0.525, p = 0.040–0.003). Results showed that participation in adapted sport has a positive effect on bone health in athletes with unilateral lower limb amputation but is not sufficient to maintain adequate levels of bone mineralization at the impaired hip in athletes with above-knee amputation. Accordingly, physical conditioners should consider implementing sporting programs, according to the severity of the impairment, aimed at improving bone mineralization at the impaired hip and improve body composition in the residual impaired leg.

Developing an exercise intervention to improve bone mineral density in traumatic amputees: protocol for a Delphi study

“…The outcomes of these studies have the potential to improve exercise prescription in amputees and if the intervention is proven successful, may stabilise or improve bone mineral density and potentially reduce lifelong fracture risk within this population. The addition of a specific exercise loading programme to increase BMD in amputees seems particularly pertinent considering recent evidence that neither walking7 nor sporting activity32 appear enough to prevent hip demineralisation in amputees. The target of this work will be individuals who have suffered traumatic amputations, as those with cancer-related or dysvascular amputations33 may require more individualised, adapted exercise regimes due to comorbidities 34…”

High prevalence of low bone mineral density but normal trabecular bone score in Norwegian elite Para athletes

“…Athletes' BMD is expected to be 10%–15% higher than age-matched non-athletes ( 3 ), but differs between sports ( 4 , 5 ). Also, in athletes with physical impairment (Para athletes), BMD is supposed to vary by type of physical impairment, ambulatory status and to be site specific ( 6 , 7 ). There is evidence of a protective effect of exercise to maintain BMD in Para athletes, however, only above the level of injury ( 6 , 8 , 9 ).…”