Osteoporosis after spinal cord injury

Jiang, Sheng‐Dan; Dai, Li-Yang; Jiang, Lei‐Sheng

doi:10.1007/s00198-005-2028-8

Cited by 250 publications

(160 citation statements)

References 110 publications

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“…Within the postmenopausal group, the occurrence of OP was more frequent at the weaker hip than the stronger hip (mean femoral T score in the weaker hip: –2.8 and mean femoral T score in the stronger hip: –0.5; p < 0.05). This striking finding is likely due to a combination of reduced muscle mass and reduced loading in the weaker leg and is in keeping with prior studies showing reduced BMD at the hip in patients with lower extremity weakness and in spinal cord injury patients with paralysis [13,25]. …”

Section: Discussionsupporting

confidence: 89%

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High Incidence of Osteoporosis and Fractures in an Aging Post-Polio Population

Akheel¹,

Khan²,

Galvin

et al. 2009

Eur Neurol

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Background/Aims: Since the polio epidemic in Ireland in the 1950s, most polio survivors are approaching into the 6th and 7th decade of their lives. There is little data about bone density and risk of fractures in these patients. In 2006, we undertook an audit of post-polio patients attending rheumatology and neurology outpatient clinics in a university teaching hospital. Our aim was to determine the prevalence of osteoporosis (OP), falls and fractures and to evaluate the association of bone density with other potential contributing factors to OP. Methods: Over a 6-month period, 50 post-polio patients attending outpatient clinics completed a questionnaire, and subsequently their medical records were reviewed. Demographic data and details of treatment were extracted. The patients underwent a dual-energy X-ray absorptiometry scanning to quantify bone mineral density. Results: Thirty subjects (60%) were females (26 were postmenopausal). The average age of females was 60 ± 13.4 years and of men 59 ± 16.8 years. Overall, 41 (82%) of the patients had experienced falls in the last 5 years and 32 (64%) in the last 6 months. Nineteen (38%) of the patients had experienced a bone fracture in the last 5 years. Based on the bone mineral density data, 28 (56%) of the patients were diagnosed with OP and 20 (40%) had osteopenia, but only 8 (16%) received anti-resorptive therapy. Of the 19 patients who had a fracture, 14 (74%) had OP and 5 (26%) had osteopenia, of whom only 6 (32%) received anti-resorptive therapy. Eight out of 9 fractures of the neck of femur occurred in the weaker leg. Conclusions: Post-polio patients are a high-risk group for fracture, and thus bone density assessment, review of falls risk and therapeutic intervention should be considered for all patients. Both osteopenia and OP are associated with increased fracture risk.

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Section: Discussionsupporting

confidence: 89%

“…All these factors suggest post-polio patients would have low BMD and would be at risk of OP [2,3,4,11,12]. Post-polio patients may also have an increased likelihood of falling, as described in patients with other neurological disorders [2,3,4,13,14] and, as a consequence, could have an increased risk of fractures.…”

Section: Introductionmentioning

confidence: 99%

High Incidence of Osteoporosis and Fractures in an Aging Post-Polio Population

Akheel¹,

Khan²,

Galvin

et al. 2009

Eur Neurol

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“…The finding of a reduced BMD in MS is similar to that seen in other disabling diseases such as spinal cord injury (SCI) [24][25][26] and stroke [27][28][29] where there is also a correlation between BMD and the degree of immobility. In SCI, BMD is significantly lower in complete compared to incomplete lesions [24], and after stroke, BMD falls more rapidly at the proximal femur of the paretic side in "nonambulatory patients than in those who are ambulatory [26,28,29].…”

Section: Bone Health In Msmentioning

confidence: 58%

“…In SCI, BMD is significantly lower in complete compared to incomplete lesions [24], and after stroke, BMD falls more rapidly at the proximal femur of the paretic side in "nonambulatory patients than in those who are ambulatory [26,28,29]. The pattern of bone loss seen in MS-greater at the femoral neck than the lumbar spine-is comparable to SCI [26] and the reduction in physiological loading of the hip may be an explanation for this. The spine, however, is subject to relatively greater forces in the sitting position and over time accumulates degenerative changes, thereby elevating BMD when measured by dual-energy X-ray absorptiometry (DXA).…”

Section: Bone Health In Msmentioning

confidence: 99%

Bone health in multiple sclerosis

Gibson

Summers

2011

Osteoporos Int

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People who are disabled with multiple sclerosis (MS) may be at increased risk of osteoporosis. This review discusses issues relevant to bone health in MS and makes practical recommendations regarding prevention and screening for osteoporosis and fracture risk in MS. A search of the literature up until 5 April 2011 was performed using key search terms, and articles pertinent to bone health in MS were analysed. Bone mineral density (BMD) is reduced at the lumbar spine, hip and total body in MS, with the degree of reduction being greatest at the hip. A strong relationship exists between the disability level, measured by the Expanded Disability Status Score, and BMD at the lumbar spine and femoral neck, particularly the latter. The rate of loss of BMD also correlates with the level of disability. Pulsed corticosteroids for acute episodes of MS, even with a high cumulative steroid dose, do not significantly affect BMD, but an effect on fracture risk is yet to be elucidated. There appears to be no correlation between vitamin D levels and BMD, and the relationship between disability and vitamin D levels remains unclear. Falls and fractures are more common than in healthy controls, and the risk rises with increasing levels of disability. The principal factor resulting in low BMD and increased fracture risk in MS is immobility. Antiresorptive therapy with bisphosphonates and optimising vitamin D levels are likely to be effective interventions although there are no randomised studies of this therapy.

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“…It was reported that calcium and phosphate homeostasis was disordered in SCI patients. The impaired phosphate metabolism arose from the uncoupling bone resorption and formation [30]. In early stage of SCI serum phosphate and ionized calcium significantly increased, so did urinary calcium excretion, which led to an empirical conclusion that the bone mineral phase was released into the blood circulation and outside the body [31,32].…”

Section: Discussionmentioning

confidence: 99%