Bone mineral status in paraplegic patients who do or do not perform standing

Goemaere, Stefan; Laere, Myriam Van; Neve, P De; Kaufman, Jean‐Marc

doi:10.1007/bf01623058

Cited by 108 publications

(77 citation statements)

References 16 publications

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“…Goemaere et al (21) reported an increase in bone density of the femoral shaft but not of the hip region in their patients with SCI who were standing for therapeutic purposes. A recent study demonstrated that body weight-supported treadmill training did not prevent bone loss in patients with SCI (22).…”

Section: Discussionmentioning

confidence: 96%

Does Standing Protect Bone Density in Patients With Chronic Spinal Cord Injury?

Göktepe

Tuğcu

Yılmaz

et al. 2008

The Journal of Spinal Cord Medicine

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Background/Objective: To compare the t-scores of proximal femur and lumbar spine of patients with spinal cord injury (SCI) with different levels of weight bearing. Methods: Cross-sectional study comparing 3 groups of patients with SCI: patients with daily standing times of more than 1 hour, patients with daily standing times of less than 1 hour, and nonstanding patients. Seventy-one patients with chronic SCI were recruited. They were assigned to 1 of 3 groups according to their reported daily standing time. The bone density of lumbar and proximal femoral regions was measured with dual-energy x-ray absorptiometry. Results: The 3 groups were similar in terms of demographics and clinical variables. No significant difference was found among the mean t-scores of lumbar and proximal femoral regions of the groups. However, the patients in the group that stood more than 1 hour daily had a slight tendency to have higher t-scores than those in the control group. Conclusions: There was no significant difference among the 3 groups. However, standing might be partially helpful in protecting the bone density in SCI by opposing the effects of immobilization.

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Section: Discussionmentioning

confidence: 96%

Does Standing Protect Bone Density in Patients With Chronic Spinal Cord Injury?

Göktepe

Tuğcu

Yılmaz

et al. 2008

The Journal of Spinal Cord Medicine

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“…These patients tend to have higher bone mineral density and thus a higher bone biomechanical competence than patients not performing standing. 17 On the other hand the patients who do not use standing devices are often more handicapped and are thus less prone to trauma. The observed borderline Fractures in spinal cord injury P Vestergaard et al signi®cant di erence may be due to the uncertainties stemming from the relatively low number currently using standing devices.…”

Section: Discussionmentioning

confidence: 99%

Fracture rates and risk factors for fractures in patients with spinal cord injury

Vestergaard¹,

Krogh²,

Rejnmark³

et al. 1998

Spinal Cord

233

181

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Aim: To study fracture rates and risk factors for fractures in patients with spinal cord injuries. Material and methods: A self-administered questionnaire was mailed to 646 members of the Danish Paraplegic Association and 1000 randomly selected normal controls. 438 patients (309 males, 129 females, 67.8%) and 654 controls (332 males, 322 females, 65.4%) returned the questionnaire. Median age in patients was 42, range 10 ± 80 years, and in controls 43, range 19 ± 93 years (2p=0.25). Results: The crude fracture rate was 2% per year in patients and 1% per year in controls (RR=2.0, P50.001). Low-energy fractures were much more prominent in patients (19.0% of all fractures) than in controls (1.4%, P50.001). The fracture rate did not di er before the injury but increased after the injury to a constant level from the third year and forward. Fractures of the lower extremities were more prominent in patients than controls (femurs: RR=23.4, P50.001, lower legs: RR=5.2, P50.001, feet/toes: RR=2.4, P=0.006) while fractures of the forearms (P50.001) and clavicles (P=0.03) were absent among patients. Fractures were more frequent in female patients (RR=1.6, P=0.008) and in male patients with a family history of fractures (RR=2.0, P=0.004). Conclusions: Low-energy fractures especially of the lower extremities are frequent in spinal cord injury patients and especially among female patients. The forearms seem protected from fractures.

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“…Higher risk of lower extremities fractures has to be taken into consideration when standing or non-standing is used as a rehabilitation means in persons with SCI. 26 Studies with a di erent duration of daily standing training are needed to see the exact e ect of axial weight loading on the changes of BMD in SCI subjects. …”

Section: Discussionmentioning

confidence: 99%

“…9 In some subjects with tetraplegia, during the early phase after SCI the calcium balance can become negative and can lead to a serious hypercalcemia. 28 An increase in bone mineral density resulting from intensive training programs could not feasibly be achieved, but some in¯uence on bone mineral density could be shown by passive weight bearing, 26,29 walking with orthoses 30 or electrically induced ergometry training for lower extremities. 31 The aim of the present study was to evaluate the trabecular and cortical BMD development for upper and lower extremities in subjects with paraand tetraplegia and to obtain more detailed information about the factors in¯uencing this development over the time after SCI.…”

Section: Introductionmentioning

confidence: 99%

True

2000

Spinal Cord

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Objective: To evaluate the loss of trabecular and cortical bone mineral density in radius, ulna and tibia of spinal cord injured persons with di erent levels of neurologic lesion after 6, 12 and 24 months of spinal cord injury (SCI). Design: Prospective study in a Paraplegic Centre of the University Hospital Balgrist, Zurich. Subjects and methods: Twenty-nine patients (27 males, two females) were examined by the highly precise peripheral quantitative computed tomography (pQCT) soon after injury and subsequently at 6, 12 and in some cases 24 months after SCI. Using analysis of the bone mineral density (BMD), various degrees of trabecular and cortical bone loss were recognised. A rehabilitation program was started as soon as possible (1 ± 4 weeks) after SCI. The in¯uence of the level of neurological lesion was determined by analysis of variance (ANOVA). Spasticity was assessed by the Ashworth Scale. Results: The trabecular bone mineral density of radius and ulna was signi®cantly reduced in subjects with tetraplegia 6 months (radius 19% less, P50.01; ulna 6% less, P40.05) and 12 months after SCI (radius 28% less, P50.01; ulna 15% less, P50.05). The cortical bone density was signi®cantly reduced 12 months after SCI (radius 3% less, P50.05; ulna 4% less, P50.05). No changes in BMD of trabecular or cortical bone of radius and ulna were detected in subjects with paraplegia. The trabecular BMD of tibia was signi®cantly reduced 6 months (5% less, P50.05) and 12 months after SCI (15% less, P50.05) in all subjects with SCI. The cortical bone density of the tibia only was decreased after a year following SCI (7% less, P50.05). No signi®cant di erence between both groups, subjects with paraplegia and subjects with tetraplegia was found for tibia cortical or trabecular BMD. There was no signi®cant in¯uence for the physical activity level or the degree of spasticity on bone mineral density in all subjects with SCI. Conclusions: Twelve months after SCI a signi®cant decrease of BMD was found in trabecular bone in radius and in tibia of subjects with tetraplegia. In subjects paraplegia, a decrease only in tibia BMD occurred. Intensity of physical activity did not signi®cantly in¯uence the loss of BMD in all subjects with para-and tetraplegia. However, in some subjects regular intensive loading exercise activity in early rehabilitation (tilt table, standing) can possibly attenuate the decrease of BMD of tibia. No in¯uence was found for the degree of spasticity on the bone loss in all subjects with SCI. Spinal Cord (2000) 38, 26 ± 32

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Bone mineral status in paraplegic patients who do or do not perform standing

Cited by 108 publications

References 16 publications

Does Standing Protect Bone Density in Patients With Chronic Spinal Cord Injury?

Does Standing Protect Bone Density in Patients With Chronic Spinal Cord Injury?

Fracture rates and risk factors for fractures in patients with spinal cord injury

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