Acute bone changes after lower limb amputation resulting from traumatic injury

Bemben, Debra A.; Sherk, Vanessa D.; Ertl, William

doi:10.1007/s00198-017-4018-z

Cited by 21 publications

(20 citation statements)

References 37 publications

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“…Instead, the regional %FM in athletes with AMP was characterized by a significantly lower (−2.6%) value in the arms vs. the whole-body %FM and by an asymmetrical %FM in the legs with the %FM in the impaired leg being significantly higher than that at the whole-body level (+13.5%). The results of the present study on athletes with AMP expand on previous investigations on non-athletic populations with AMP ( Sherk, Bemben & Bemben, 2008 ; Bemben et al, 2017 ), which reported that the regional alterations in body composition mainly affected the impaired limb and involved muscle atrophy and an increase in the amount of FM.…”

Section: Discussionsupporting

confidence: 84%

“…Lower BMD in the legs of wheelchair athletes was also found in the study conducted by Miyahara and colleagues (2008) and can be explained by the serious adverse effects of immobilization on leg bones associated with a reduction of the effects of gravity and denervation atrophy (Spungen et al, 2003;Mojtahedi, Valentine & Evans, 2009). Our findings expand on previous findings on non-athletic subjects with AMP (Sherk, Bemben & Bemben, 2008;Bemben et al, 2017) showing that bone demineralization in the impaired leg also occurs in athletes with AMP despite the practice of sport activity. In the future it would be interesting to explore whether the type of locomotion used in the sport practiced by athletes with AMP may have an impact on BMD in the impaired leg (e.g., wheelchair sports, prosthetic sports like track and field and Para Table Tennis, unassisted sports like Para Swimming).…”

Section: Regional Analysissupporting

confidence: 89%

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Body composition and bone mineral density in athletes with a physical impairment

Cavedon

Sandri

Peluso

et al. 2021

PeerJ

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Background The impact of the type and the severity of disability on whole-body and regional body composition (BC), and bone mineral density (BMD) must be considered for dietary advice in athletes with a physical impairment (PI). This study aimed to investigate the impact of the type and the severity of disability on BC, the pattern of distribution of fat mass at the regional level, and BMD in athletes with a PI. Methods Forty-two male athletes with spinal cord injury (SCI, n = 24; age = 40.04 ± 9.95 years, Body Mass Index [BMI] = 23.07 ± 4.01 kg/m2) or unilateral lower limb amputation (AMP, n = 18; age = 34.39 ± 9.19 years, BMI = 22.81 ± 2.63 kg/m2) underwent a Dual-Energy X-Ray Absorptiometry scan. Each athlete with a PI was matched by age with an able-bodied athlete (AB, n = 42; age = 37.81 ± 10.31 years, BMI = 23.94 ± 1.8 kg/m2). Results One-Way Analysis of Variance showed significant differences between the SCI, AMP and AB groups for percentage fat mass (%FM) (P < 0.001, eta squared = 0.440). Post-hoc analysis with Bonferroni’s correction showed that athletes with SCI had significantly higher %FM vs. the AMP and AB groups (25.45 ± 5.99%, 21.45 ± 4.21% and 16.69 ± 2.56%, respectively; P = 0.008 vs. AMP and P < 0.001 vs. AB). The %FM was also significantly higher in the AMP vs. the AB group (P < 0.001). Whole-body BMD was negatively affected in SCI athletes, with about half of them showing osteopenia or osteoporosis. In fact, the mean BMD and T-score values in the SCI group (1.07 ± 0.09 g/cm2 and −1.25 ± 0.85, respectively) were significantly lower in comparison with the AB group (P = 0.001 for both) as well as the AMP group (P = 0.008 for both). The type of disability affected BC and BMD in the trunk, android, gynoid and leg regions in SCI athletes and the impaired leg only in AMP athletes. Conclusions In conclusion, the type of disability and, partly, the severity of PI impact on BC and BMD in athletes with a PI. Nutritionists, sports medicine doctors, clinicians, coaches and physical conditioners should consider athletes with SCI or AMP separately. Athletes with a PI would benefit from specific nutrition and training programs taking into account the type of their disability.

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Section: Discussionsupporting

confidence: 84%

Section: Regional Analysissupporting

confidence: 89%

Body composition and bone mineral density in athletes with a physical impairment

Cavedon

Sandri

Peluso

et al. 2021

PeerJ

View full text Add to dashboard Cite

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“…and may be less biologically active since amputees load their amputated residual limb less than their unaffected limb (Bemben et al, 2017). In general, intravenous antibiotics seem to offer no advantage to oral antibiotics for orthopedic infections (Li et al, 2019).…”

Section: Discussionmentioning

confidence: 99%

Unexpected positive intraoperative cultures (UPIC) at index osseointegration do not lead to increased postoperative infectious events

Hoellwarth

Reif

Henry

et al. 2022

J. Bone Joint Infect.

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Abstract. Introduction: The most common complication following transcutaneous osseointegration for amputees is infection. Although an obvious source of contamination is the permanent stoma, operative site contamination at the time of implantation may be an additional source. This study investigates the impact of unexpected positive intraoperative cultures (UPIC) on postoperative infection. Methods: Charts were reviewed for 8 patients with UPIC and 22 patients with negative intraoperative cultures (NIC) who had at least 1 year of post-osseointegration follow-up. All patients had 24 h of routine postoperative antibiotic prophylaxis, with UPIC receiving additional antibiotics guided by culture results. The main outcome measure was postoperative infection intervention, which was graded as (0) none, (1) antibiotics unrelated to the initial surgery, (2) operative debridement with implant retention, or (3) implant removal. Results: The UPIC vs. NIC rate of infection management was as follows: Grade 0, 6/8 = 75 % vs. 14/22 = 64 %, p = 0.682; Grade 1, 2/8 = 25 % vs. 8/22 = 36.4 % (Fisher's p = 0.682); Grade 2, 1/8 = 12.5 % vs. 0/22 = 0 % (Fisher's p = 0.267); Grade 3, 0/8 = 0 % vs. 1/22 = 4.5 % (Fisher's p = 1.000). No differences were statistically significant. Conclusions: UPIC at index osseointegration, managed with directed postoperative antibiotics, does not appear to increase the risk of additional infection management. The therapeutic benefit of providing additional directed antibiotics versus no additional antibiotics following UPIC is unknown and did not appear to increase the risk of other adverse outcomes in our cohort.

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“…It is known that cortical bone components play important roles in maintaining the axial load bearing capacity of long bones 29 , 30 , thus the amplitude of mechanical load on a long bone, which is mainly composed of cortical bone components, might determine its strength 31 , 32 . A previous study that utilized HR-pQCT demonstrated that impaired cortical bone components in particular increased cortical porosity and are responsible for fragility fractures in postmenopausal T2DM females 9 .…”

Section: Discussionmentioning

confidence: 99%

Association of Decreased Handgrip Strength with Reduced Cortical Thickness in Japanese Female Patients with Type 2 Diabetes Mellitus

Nakamura

Inaba

Yamada

et al. 2018

Sci Rep

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LD-100, a quantitative ultrasonic device, allows us to measure cortical thickness (CoTh). Patients with type 2 diabetes mellitus (T2DM) show high prevalence of sarcopenia. This study aimed to clarify the association of handgrip strength (HGS) with cortical porosis, a major risk for fracture of DM. CoTh and trabecular bone mineral density (TrBMD) at the 5.5% distal radius were assessed in T2DM female patients (n = 122) and non-DM female controls (n = 704) by LD-100. T2DM patients aged older 40 years showed significantly lower HGS and CoTh, but not TrBMD, than non-DM counterparts. Although HGS was significantly and positively correlated with CoTh and TrBMD in T2DM patients, multivariate analysis revealed HGS as an independent factor positively associated with CoTh, but not TrBMD, in T2DM patients, suggesting the preferential association of HGS with cortical, but not trabecular, bone component in T2DM female patients. In conclusion, the present study demonstrated an early decline of HGS in T2DM female patients as compared with non-DM healthy controls after the age of 40 years, which is independently associated with thinner CoTh, but not TrBMD in T2DM patients, and thus suggested that reduced muscle strength associated with DM might be a major factor for cortical porosis development in DM patients.

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Acute bone changes after lower limb amputation resulting from traumatic injury

Abstract: Rapid and substantial losses in bone content and strength occur early after amputation and are not regained by 12 months of becoming ambulatory. Early post-amputation may be the most critical window for preventing bone loss.

Cited by 21 publications

References 37 publications

Body composition and bone mineral density in athletes with a physical impairment

Body composition and bone mineral density in athletes with a physical impairment

Unexpected positive intraoperative cultures (UPIC) at index osseointegration do not lead to increased postoperative infectious events

Association of Decreased Handgrip Strength with Reduced Cortical Thickness in Japanese Female Patients with Type 2 Diabetes Mellitus

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