Bone steady-state is established at reduced bone strength after spinal cord injury: A longitudinal study using peripheral quantitative computed tomography (pQCT)

Frotzler, Angela; Berger, Markus F.; Knecht, Hans; Eser, Prisca

doi:10.1016/j.bone.2008.05.006

Cited by 84 publications

(74 citation statements)

References 38 publications

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“…The variability is clearly not completely explained by gender or lesion category. Through a longitudinal pQCT study following 39 SCI patients for 30 months, Frotzler et al [20] have recently shown that key bone parameters do not change significantly in individual patients after 3 years postinjury.…”

Section: Discussionmentioning

confidence: 99%

Role of peripheral quantitative computed tomography in identifying disuse osteoporosis in paraplegia

2009

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Objective: Disuse osteoporosis is a major long-term health consequence of spinal cord injury (SCI) that still needs to be addressed. Its management in SCI should begin with accurate diagnosis, followed by targeted treatments in the most vulnerable subgroups. We present data quantifying disuse osteoporosis in a cross-section of the Scottish paraplegic population to identify subgroups with lowest bone mineral density (BMD). Materials & Methods:Forty-seven people with chronic SCI at levels T2-L2 were scanned using peripheral Quantitative Computed Tomography (pQCT) at four tibial sites and two femoral sites, at the Queen Elizabeth National Spinal Injuries Unit, Glasgow (U.K.). At the distal epiphyses, trabecular BMD (BMDtrab), total BMD, total bone cross-sectional area (CSA), and bone mineral content (BMC) were determined. In the diaphyses, cortical BMD, total bone CSA, cortical CSA, and BMC were calculated. Bone, muscle and fat CSAs were estimated in the lower leg and thigh.Results: BMDtrab decreased exponentially with time since injury, at different rates in the tibia and femur. At most sites, female paraplegics had significantly lower BMC, total bone CSA and muscle CSA than male paraplegics. Subjects with lumbar SCI tended to have lower bone values and smaller muscle CSAs than in thoracic SCI. Conclusion:At the distal epiphyses of the tibia and femur, there is generally a rapid and extensive reduction in BMDtrab after SCI. Female subjects, and those with lumbar SCI, tend to have lower bone values than males or those with thoracic SCI, respectively.

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Section: Discussionmentioning

confidence: 99%

Role of peripheral quantitative computed tomography in identifying disuse osteoporosis in paraplegia

2009

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“…A recent publication found different DOP until steady state for different parameter and scan sites [24]. Based on previously published cross-sectional data from a large number of subjects with paraplegia and tetraplegia [7], Frotzler et al performed all statistical analyses of tibial and femoral bone data, including only subjects with a lesion duration of at least the time to reach bone steady state (t) for each particular bone parameter calculated from bone measurements at t0 [24]. They chose the cutoff point of 8 years because this was the maximum time required for the femur and tibia to reach the new steady state [7].…”

Section: Figurementioning

confidence: 97%

“…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]. Based on previously published cross-sectional data from a large number of subjects with paraplegia and tetraplegia [7], Frotzler et al performed all statistical analyses of tibial and femoral bone data, including only subjects with a lesion duration of at least the time to reach bone steady state (t) for each particular bone parameter calculated from bone measurements at t0 [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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“…3,4 Both dual-energy X-ray absorptiometry (DXA) and peripheral quantitative computerised tomography (pQCT) have been used to investigate bone changes after SCI. [5][6][7] Although there are large databases of DXA values in the lumbar spine, proximal femur and distal radius, most fractures in SCI patients occur in the distal femur or proximal tibia; these are not sites normally scanned by DXA and therefore there is no large database of controls. pQCT data has been reported for the distal tibia, 6,8 but not together with data on proximal tibia, which is a more common site for fractures in SCI patients.…”

Section: Introductionmentioning

confidence: 99%

Changes in the structural and material properties of the tibia in patients with spinal cord injury

et al. 2011

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Study design: A cross-sectional study. Objectives: To measure the change of structural and material properties at different sites of the tibia in spinal cord-injured patients using peripheral quantitative computerised tomography (pQCT). Setting: Orthopaedic research centre (UK). Methods: Thirty-one subjects were measured-eight with acute spinal cord injury (SCI), nine with chronic SCI and fourteen ablebodied controls. pQCT scans were performed at 2% (proximal), 34% (diaphyseal) and 96% (distal) along the tibia from the tibial plateau. Structural measures of bone were calculated, and volumetric bone mineral density (vBMD) was also measured at all three levels. Muscle cross-sectional area was measured at the diaphyseal level. Results: Structurally, there were changes in the cortical bone; in the diaphysis, the shape of the cross-section changed to offer less resistance to AP bending, and the cross-sectional area of the cortical shell decreased both proximally and distally. There were corresponding changes in vBMD in the anterior aspect of the cortical diaphysis, as well as proximal and distal trabecular bone. Changes in muscle occurred more rapidly than changes in bone. Conclusion: There were clear changes of both structure and material at all three levels of the tibia in chronic SCI patients. These changes were consistent with specific adaptations to reduced local mechanical loading conditions. To assess fracture risk in SCI and also to monitor the effect of therapeutic interventions, the structure of the bone should be considered in addition to trabecular bone mineral density.

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Bone steady-state is established at reduced bone strength after spinal cord injury: A longitudinal study using peripheral quantitative computed tomography (pQCT)

Cited by 84 publications

References 38 publications

Role of peripheral quantitative computed tomography in identifying disuse osteoporosis in paraplegia

Role of peripheral quantitative computed tomography in identifying disuse osteoporosis in paraplegia

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

Changes in the structural and material properties of the tibia in patients with spinal cord injury

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