Bone And Soft Tissue Changes In Patients With Spinal Cord Injury And Multiple Sclerosis

Abstract

In patients with spinal cord injury and multiple sclerosis, deterioration of body composition (changes in bone, fat and muscle mass) is associated with increased risk for diseases such as coronary artery heart disease, non-insulin dependent diabetes mellitus, lipid metabolism abnormalities, and osteoporotic fractures in these patients. Immobility leads to a changing pattern of loading in the paralyzed areas, and secondary alteration in structure. However, bone and soft tissue changes in these patients are usually neglected. The purpose of this article is to update on the pathophysiological mechanisms leading to bone and soft tissue changes, and to increase the awareness of the treating physicians with respect to bone, muscle and fat loss and their consequences aiming to obtain measures to prevent bone and soft tissue loss in these patients.Key words: spinal cord injury, multiple sclerosis, bone, muscle and fat loss, osteoporosis Folia Medica 2014; 56(4): 237-244 Copyright © 2014 Medical University, Plovdiv РЕЗЮМЕ У пациентов с травмами позвонкового мозга и со сопутствующим склерозом ухудшенная структура тела /изменения тела, жиры и мышечная масса/ связана с повышенным риском появления заболеваний как коронарная болезнь сердца, инсулинозависимый сахарный диабет, нарушенный метаболизм жиров, как и появление остеопоротических фрактур. Гипокинезия приводит к изменениям в моделях нагрузки парализованных областей как и к вторичным структурным изменениям. Несмотря на это обычно пациенты не обращают внимания на изменения костей и мягких тканей. Настоящая работа ставит себе целью актуализовать патофизиологические механизмы, приводящие к изменениям костных и мягких тканей, а также и повысить информированность лечащих врачей относительно костных, липидных и мышечных потерь и их последствий с целью принятия необходимых превентивных мер, чтобы уменьшить потери соответствующих тканей.Ключевые слова: травмы позвонкового мозга, множественный склероз, кости, мышечная и липидная (жировая) потеря, остеопороз Folia Medica 2014; 56(4): 237-244

A comparison of exercise interventions from bed rest studies for the prevention of musculoskeletal loss

“…These patients are different from the patients in bed rest studies, and require rehabilitation that is not highly intensive and is able to target specific muscle and bone groups. 65 Dauty et al 66 found that the loss of bone mass is greatest in the lower limb (70% in the distal femur and 52% in the proximal tibia) in spinal cord injury patients. Such patients with paralysis would have to rely on vibration technology which simulates neuromuscular activation and induces mechanical stress on bone.…”

Body Composition in Paraplegia

“…A paraplegic subject could be wheelchair bound, may have an alternated walking gait pattern but may also be unable to walk at all [10,11]. In addition to these differences and according to osteoporosis the role of factors which do not change, such as race or gender of patients has not been yet clarified, although there are few studies in women debating that bone mass in women with paraplegia is more affected than men [12,13].…”

Gastrodin ameliorates spinal cord injury via antioxidant and anti-inflammatory effects

“…The acute SCI could result in a bruise, a partial tear, or a complete tear in the spinal cord (Alkabie & Boileau, 2015;Sothmann et al, 2015). The primary SCI could degrade key cytoskeletal and activate functional proteins, leading to delayed death of local and adjacent neurons and glial cells (Dionyssiotis et al, 2014;Henke et al, 2015). Primary injury is considered to be an irreversible mechanical damage (Evaniew et al, 2015).…”