The effect of low magnitude mechanical stimulation (LMMS) on bone density in patients with Rett syndrome: A pilot and feasibility study

Abstract

PURPOSE: Low magnitude mechanical stimulation (LMMS) has been used successfully to promote bone formation in certain patient populations. This study evaluated the feasibility and effectiveness of LMMS on improving bone mineral density (BMD) in patients with Rett syndrome. METHODS: A 12-month crossover pilot study design of 6 months of intervention with LMMS and 6 months without was studied in 14 subjects divided in two subgroups. BMD was assessed using Dual Energy X-ray Absorptiometry (DXA). The levels of 25-hydroxy vitamin D (25OHD), Parathyroid Hormone (PTH), Insulin-Like Growth Factor 1 (IGF-1), and circulating markers of bone resorption (NTx) were analyzed in blood samples. Health questionnaires and diet logs were obtained at 0, 6, and 12 months. RESULTS: Of the 11 subjects who completed the protocol, 9 had an adherence of > 65% and showed an increase in spine BMD Z-scores from the intervention (Z: −2.51) compared to non-intervention period (Z: −2.27) of 0.23 SD (p = 0.048). Following intervention, favorable trends were also observed for IGF-1 (p = 0.06) and right distal femur BMD Z-scores (p = 0.07). CONCLUSIONS: These preliminary results are promising for a larger, placebo-controlled randomized study of subjects with Rett syndrome.

Effect of Low-Intensity Vibration on Bone Strength, Microstructure, and Adiposity in Pre-Osteoporotic Postmenopausal Women: A Randomized Placebo-Controlled Trial

“…It should be noted that most previous studies that reported beneficial effects of low‐intensity vibration intervention involved cohorts with severely compromised bone quality at baseline. For example, vibration interventions have been found to be beneficial in patients with renal osteodystrophy, ( 33 ) disabling conditions, ( 25 ) idiopathic scoliosis, ( 26 ) cerebral palsy, ( 27 ) Crohn's disease, ( 31 ) Rett syndrome, ( 48 ) child cancer survivors, ( 49 ) and young women (aged 15 to 20 years) with low BMD and a history of bone fracture. ( 23 ) These studies, taken together with the results of the present work, suggest that low‐intensity vibration may be best suited for individuals with compromised bone quality lacking regular stimulatory cues.…”

“…On the other hand, recent studies have highlighted the benefit of this form of intervention, with efficacy increasing with greater adherence. ( 23,31,33,48,49 ) More reliable adherence monitoring was possible in our study because of the recording electronics inside the vibrating platforms, rather than using self‐reported device usage data. Further, routine communication between the participants and research coordinators might have positively affected adherence achieved in our study.…”

Altered Bone Status in Rett Syndrome

“…Several evidences demonstrated the ability of mechanical stimuli to modulate bone formation and remodeling. Accordingly, a significant improvement in spine bone mineral density was observed in nine RTT patients enrolled in a 12-month crossover pilot study designed as a 6-month intervention period with LMMS and a 6-month period without [135]. Based on these preliminary data, LMMS could be considered as an additional feasible intervention to associate with previous reported therapeutic approaches, although further evaluation on larger cohorts of RTT patients is needed.…”

“…Finally, it is worth mentioning the results of a study evaluating the effectiveness of low magnitude mechanical stimulation (LMMS) in improving bone mineral density in RTT patients [135]. Several evidences demonstrated the ability of mechanical stimuli to modulate bone formation and remodeling.…”

Does Whole-Body Vibration Treatment Make Children’s Bones Stronger?

“…A randomized controlled pilot study with WBV treatment in 20 children with CP detected improved mobility function but did not detect any positive effect on bone tissue after 6 months of treatment [21]. However, positive effects on cortical and trabecular bone have been demonstrated in a number of studies on patients with CP and Rett syndrome [22][23][24][25][26][27]. Saquetto et al [40••] published a systematic review with meta-analysis on 6 studies with 176 children with CP demonstrating increased femur BMD after WBV intervention.…”