Intensive exercise may preserve bone mass of the upper limbs in spinal cord injured males but does not retard demineralisation of the lower body

Jones, Lynnette M.; Legge, Michael; Goulding, Ailsa

doi:10.1038/sj.sc.3101286

Cited by 70 publications

(37 citation statements)

References 35 publications

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“…5,16,17 An alternative is to measure length. Jones et al 21 reported the Pearson's correlation coefficient for height (measured by wall-mounted stadiometer) versus length (by the electronic ruler function of DXA) to be 0.996 (P ¼ 0.0001). Buchholz et al 22 found the coefficient of variation between height (by wall-mounted stadiometer) versus length (by length board) to be 0.870.02% (mean7SD, NS).…”

Section: Body Mass Index (Bmi) As a Marker Of Obesity In Chronic Scimentioning

confidence: 99%

A review of body mass index and waist circumference as markers of obesity and coronary heart disease risk in persons with chronic spinal cord injury

2005

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Study design: Literature review. Background: Increased fat mass and coronary heart disease (CHD) are secondary complications of chronic spinal cord injury (SCI). In able-bodied populations, body mass index (BMI, body weight (kg)/height (m 2 )) is a widely used surrogate marker of obesity and predictor of CHD risk. Waist circumference, an accurate and reproducible surrogate measure of abdominal visceral adipose tissue, is also associated with CHD risk (more so than BMI) in able-bodied populations. Objective: To review the literature on the accuracy of BMI and waist circumference as surrogate measures of obesity and CHD risk in persons with chronic SCI. Setting: Ontario, Canada. Methods: Literature review. Results: In the SCI population, BMI is an insensitive marker of obesity, explains less of the variance in measured percent fat mass than in the able-bodied, and is inconsistently related to CHD risk factors. This may be due to potential measurement error, and to the inability of BMI to distinguish between fat and fat-free mass and to measure body fat distribution. Waist circumference has not been validated as a surrogate measure of visceral adipose tissue, however preliminary evidence supports a relationship between waist circumference and CHD risk in the SCI population. Conclusions: We recommend that SCI-specific BMI classifications be determined. We also recommend that accuracy and reliability of waist circumference as a surrogate measure of visceral adipose tissue and CHD risk be determined in men and women with long-standing paraplegia and tetraplegia. Body mass index (BMI) as a marker of obesity in chronic SCIObesity is defined as an excess accumulation of fat mass. Able-bodied men and women p40 years are considered obese when fat mass exceeds 22-25 and 35% of body weight, respectively. 1,2 As individuals age, fat mass accrues at the expense of fat-free mass, so that at older ages percentage fat mass is higher, even in individuals who do not gain weight. 3 Thus, obesity in 41-60-yearold able-bodied men and women can be defined as a fat mass 425 and 438% of body weight, respectively. 2 Mean percent fat mass (measured by dual energy X-ray absorptiometry (DXA), isotope dilution or the threecompartment model) reported in cross-sectional studies of persons (mostly men) with chronic spinal cord injury (SCI) ranges from 23 to 35%. [4][5][6][7][8][9][10][11] The percentage of body weight as fat mass is 8-18% higher in SCI versus age-, height-and/or weight-matched able-bodied control subjects. These values are often consistent with the above definitions of obesity, and are summarized in Table 1. Accurate classification of an individual as normal weight, overweight or obese requires measurement of body composition. However, measuring fat mass can be difficult and expensive, and no accurate method is easily available for routine clinical use. Therefore, the body mass index (BMI) is widely used. Expressed as weight (kg) divided by height (m 2 ), BMI allows classification of able-bodied adults as underweight, normal we...

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Section: Body Mass Index (Bmi) As a Marker Of Obesity In Chronic Scimentioning

confidence: 99%

A review of body mass index and waist circumference as markers of obesity and coronary heart disease risk in persons with chronic spinal cord injury

2005

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“…These changes are associated with increased risk for pathological fractures, nephrolithiasis, nephrocalcinosis, frank hypercalcemia, and heterotopic ossification at the knees (5-7). The effects of exercise and muscle contractions on bone mineral density in patients with SCI are contradictory and as yet unproven (8,9).…”

Section: Introductionmentioning

confidence: 99%

Effect of a Convenient Single 90-mg Pamidronate Dose on Biochemical Markers of Bone Metabolism in Patients With Acute Spinal Cord Injury

Mechanick

Liu

Nierman

et al. 2006

The Journal of Spinal Cord Medicine

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Background/Objective: To describe the biochemical and adverse effects of a convenient single 90 mg pamidronate dose in patients with acute spinal cord injury (SCI) and compare these effects with those observed in a previous similar study using a 30 mg/d 3 3-day pamidronate dosing regimen.Study Design: Retrospective cohort study.Setting: University-based rehabilitation center in New York City.Methods: A total of 32 patients with SCI were evaluated for biochemical response and adverse events associated with pamidronate therapy. All patients were screened at or near admission for acute rehabilitation, received calcium (1,000 mg daily) and calcitriol (0.25 lg daily) therapy daily, and on day 4, received a single dose of pamidronate, 90 mg by intravenous infusion, over 4 hours. Serum calcium and phosphate levels were closely monitored, and 2 weeks after pamidronate, biochemical bone markers were re-evaluated.Results: Responses of biochemical markers of bone resorption (N-telopeptide and 24-hour urinary calcium excretion) to pamidronate 90 mg were consistent with an antiresorptive effect, although less than that observed with a 30 mg/d 3 3-day pamidronate dosing regimen. The frequency of hypocalcemia was greater, and hypophosphatemia was less than the 30 mg/d 3 3-day pamidronate dosing regimen. Fever was more frequent (78%) with the 90-mg single dose of pamidronate compared with the 30 mg/d 3 3-day pamidronate dosing regimen (20%).Conclusions: Single-dose pamidronate 90 mg is effective at reducing biochemical markers of bone hyperresorption in patients with acute SCI but is associated with a greater incidence of fever compared with a 30 mg/d 3 3-day dosing regimen.

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“…21 Paradoxically, at the lumbar spine, which is mainly constituted of trabecular bone, no reduction in BMD occurs whatever the lesion level or postinjury duration. 1,3,11,[16][17][18][22][23][24][25][26][27][28][29][30][31] This has been demonstrated to be due to continuous body weight-bearing during wheelchair use. 1,11,23,24 However, it should be kept in mind that in certain cases, BMD at the lumbar spine can be 'falsely increased' by neuropathic spondylopathy.…”

Section: Introductionmentioning

confidence: 99%

Bone loss in spinal cord-injured patients: from physiopathology to therapy

et al. 2005

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Study design: Review article on bone metabolism and therapeutic approach on bone loss in patients with spinal cord injury (SCI). Objective: The first part aims to describe the process of bone demineralization and its effects on bone mass in patients with SCI. The second part describes and discusses the therapeutic approaches to limiting the alteration in bone metabolism related to neurological lesions. Setting: Propara Rehabilitation Center, Montpellier, France. Results: During the first 24 months postinjury, demineralization occurs exclusively in the sublesional areas and predominantly in weight-bearing skeletal sites such as the distal femur and proximal tibia, both of which are trabecular-rich sites. Reduced bone mass, in association with a modified bone matrix property and composition, is very likely at the origin of pathological fractures after minor trauma to which these patients are frequently exposed. Since these fractures may be asymptomatic yet may lead to complications, preventing and managing 'neurological osteoporosis' remains a considerable challenge. Two main approaches are considered: the first consists in applying a mechanical stimulus to the bone tissue by standing, orthotically aided walking or functional electrical stimulation (FES). The second uses medications, particularly antiresorptive drugs such as calcitonin or diphosphonates. Conclusion: To develop well-adapted treatments, a more precise understanding of bone loss etiology is needed. The current rehabilitation programs are based on the idea that the bone physiological changes observed in patients with SCI are due to immobility, but results indicate that alterations inherent to neurological damage may play an even greater role in inducing osteoporosis.

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Intensive exercise may preserve bone mass of the upper limbs in spinal cord injured males but does not retard demineralisation of the lower body

Cited by 70 publications

References 35 publications

A review of body mass index and waist circumference as markers of obesity and coronary heart disease risk in persons with chronic spinal cord injury

A review of body mass index and waist circumference as markers of obesity and coronary heart disease risk in persons with chronic spinal cord injury

Effect of a Convenient Single 90-mg Pamidronate Dose on Biochemical Markers of Bone Metabolism in Patients With Acute Spinal Cord Injury

Bone loss in spinal cord-injured patients: from physiopathology to therapy

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