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Bone mineral status after pediatric spinal cord injury
M Kannisto1, H Alaranta, J Merikanto
1Children's Hospital, University of Helsinki, Finland.
Insights
Spinal cord injury (SCI) sustained in childhood can lead to decreased bone mineral density (BMD) in adults, particularly in the femur. This increases fracture risk, necessitating further research into osteoporosis prevention strategies.
Area of Science:
- Orthopedics
- Neurology
- Endocrinology
Background:
- Pediatric spinal cord injury (SCI) can have long-term effects on bone health.
- Understanding the impact of SCI on bone mineral density (BMD) is crucial for managing patient care and preventing fractures.
Purpose of the Study:
- To investigate the bone mineral status in adults with childhood-onset SCI.
- To assess the relationship between lesion level and BMD.
- To evaluate bone turnover markers in this population.
Main Methods:
- Dual-energy X-ray absorptiometry (DEXA) was used to measure BMD of the lumbar spine and proximal femur.
- Biochemical markers were analyzed to estimate bone turnover.
- Clinical interviews and examinations were conducted.
Main Results:
- Lumbar spine BMD was normal, but femoral BMD was significantly decreased.
- Patients with lower SCI lesions exhibited higher BMD in both lumbar and femoral regions.
- Bone turnover markers did not indicate accelerated bone formation or resorption.
Conclusions:
- Adults with childhood SCI face an increased risk of fractures due to decreased femoral BMD.
- Caution is advised during weight-bearing activities and mobilization for patients with long-standing or pediatric SCI.
- Further research into preventing dissociated osteoporosis through pharmacotherapy and tailored physical training is recommended.
Abstract:
The impact of spinal cord injury (SCI) on later bone mineral status was studied in 35 adults who had sustained their injury in childhood. The median age of the patients was 31 years, the median age at injury 12.9 years and the median time period from injury was 19 years. The methods used in the study were clinical interview and examination, measurement of bone mineral density (BMD) of the lumbar spine and the proximal femur with dual energy X-ray absorptiometry (DEXA) and estimation of bone turnover with biochemical markers. The densitometric examination revealed that the BMD at the lumbar spine was within the normal range but grossly decreased in the femoral region. Moreover, there was a significant difference in BMD between patients with high (C2-T6) and low (below T6) lesions in the lumbar spine as well as in the femoral region. Patients with lower lesions had higher BMD values. The markers of bone turnover which were studied were serum and urinary calcium and phosphate serum alkaline phosphatase and its isoenzymes, osteocalcin, carboxyterminal propeptide of human type I procollagen (PICP), carboxyterminal telopeptide of type I collagen (ICTP) and urinary deoxypyridinoline. These markers of bone metabolism showed no signs of ongoing accelerated bone formation or resorption. The present study suggests that caution should be observed in weight bearing training or mobilisation of patients with pediatric SCI or perhaps with long standing SCI because of increased fracture risk. The prevention of dissociated osteoporosis should be investigated further in order to avoid fractures of weakened bones. The modes of prevention might be found in the use of modern pharmacotherapy of osteoporosis and from correctly dosage physical training.