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

Coupaud, S.; McLean, Andrew N.; Allan, David B.

doi:10.1007/s00256-009-0674-1

Cited by 38 publications

(29 citation statements)

References 19 publications

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“…6 Treadmill walking has been shown to improve trabecular BMD in the distal tibia but not in the proximal tibia in a case report. 8 The bone mineral content at the distal end is about 50% of that at the proximal ends, and as both proximal and distal metaphyses are loaded primarily in compression it is likely that strains in the distal tibia will be correspondingly larger, perhaps explaining the greater responsiveness of the distal bone to the absence of mechanical stimulus.…”

Section: Discussionmentioning

confidence: 99%

“…[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. It has been proposed that bone mineral should be measured round the knee, 3 and Rittweger et al measured four sites around the knee, two in the distal femur and two in the proximal tibia.…”

Section: Introductionmentioning

confidence: 98%

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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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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 98%

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

et al. 2011

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“…a severe form of MS can result in a wheelchair bound patient a clinical figure equivalent to paraplegia or a MS patient may have a more appropriate walking gait pattern vs. a patient with incomplete paraplegia but may also be unable to walk at all, is bedridden and vice versa (Dionyssiotis, 2011b;2011c;2011d). 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 disabilities is more affected than men (Smeltzer et al, 2005;Coupaud et al, 2009). …”

Section: Introductionmentioning

confidence: 99%

Body Composition in Disabilities of Central Nervous System

Dionyssiotis¹

2012

Dual Energy X-Ray Absorptiometry

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“…10 Vestergaard et al 11 reported that fractures occur in 2%-6% of people who have suffered a SCI. Cross-sectional densitometry studies 12,13 describe an exponential decrease in bone mineral density (BMD) in the first 3 years after SCI, with BMD reaching a steady-state condition at around 3-7 years post-injury, after which time chronic SCI patients are most susceptible to fracture.…”

Section: Introductionmentioning

confidence: 99%

Prediction of risk of fracture in the tibia due to altered bone mineral density distribution resulting from disuse: A finite element study

Gislason

Coupaud

Sasagawa

et al. 2014

Proc Inst Mech Eng H

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The disuse-related bone loss that results from immobilisation following injury shares characteristics with osteoporosis in post-menopausal women and the aged, with decreases in bone mineral density leading to weakening of the bone and increased risk of fracture. The aim of this study was to use the finite element method to: (i) calculate the mechanical response of the tibia under mechanical load and (ii) estimate of the risk of fracture; comparing between two groups, an able-bodied group and spinal cord injury patients group suffering from varying degrees of bone loss. The tibiae of eight male subjects with chronic spinal cord injury and those of four able-bodied age-matched controls were scanned using multi-slice peripheral quantitative computed tomography. Images were used to develop full three-dimensional models of the tibiae in Mimics (Materialise) and exported into Abaqus (Simulia) for calculation of stress distribution and fracture risk in response to specified loading conditions -compression, bending and torsion. The percentage of elements that exceeded a calculated value of the ultimate stress provided an estimate of the risk of fracture for each subject, which differed between spinal cord injury subjects and their controls. The differences in bone mineral density distribution along the tibia in different subjects resulted in different regions of the bone being at high risk of fracture under set loading conditions, illustrating the benefit of creating individual material distribution models. A predictive tool can be developed based on these models, to enable clinicians to estimate the amount of loading that can be safely allowed onto the skeletal frame of individual patients who suffer from extensive musculoskeletal degeneration (including spinal cord injury, multiple sclerosis and the ageing population). The ultimate aim is to reduce fracture occurrence in these vulnerable groups.

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

Cited by 38 publications

References 19 publications

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

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

Body Composition in Disabilities of Central Nervous System

Prediction of risk of fracture in the tibia due to altered bone mineral density distribution resulting from disuse: A finite element study

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