regional cortical and trabecular bone loss after spinal cord injury
DESCRIPTION
Regional cortical and trabecular bone loss after spinal cord injury. Shauna Dudley-Javoroski, PT, PhD; Richard K. Shields, PT, PhD, FAPTA. Aim - PowerPoint PPT PresentationTRANSCRIPT
This article and any supplementary material should be cited as follows: Dudley-Javoroski S, Shields RK. Regional cortical and trabecular bone loss after spinal cord injury. J Rehabil Res Dev. 2012;49(9):1365-76. http://dx.doi.org/10.1682/JRRD.2011.12.0245
Slideshow ProjectDOI:10.1682/JRRD.2011.12.0245JSP
Regional cortical and trabecular bone loss after spinal cord injury
Shauna Dudley-Javoroski, PT, PhD; Richard K. Shields, PT, PhD, FAPTA
This article and any supplementary material should be cited as follows: Dudley-Javoroski S, Shields RK. Regional cortical and trabecular bone loss after spinal cord injury. J Rehabil Res Dev. 2012;49(9):1365-76. http://dx.doi.org/10.1682/JRRD.2011.12.0245
Slideshow ProjectDOI:10.1682/JRRD.2011.12.0245JSP
• Aim– Measure trabecular bone mineral density (BMD) and
cortical cross-sectional area (CSA) loss at several previously unexamined lower-limb sites in individuals with spinal cord injury (SCI).
• Relevance– SCI triggers rapid loss of trabecular BMD in bone
epiphyses and loss of cortical CSA in bone diaphyses, increasing fracture risk for people with SCI.
This article and any supplementary material should be cited as follows: Dudley-Javoroski S, Shields RK. Regional cortical and trabecular bone loss after spinal cord injury. J Rehabil Res Dev. 2012;49(9):1365-76. http://dx.doi.org/10.1682/JRRD.2011.12.0245
Slideshow ProjectDOI:10.1682/JRRD.2011.12.0245JSP
Method
• Using peripheral quantitative computed tomography, we scanned:– 13 participants with SCI longitudinally. – 16 participants with SCI once.– 21 controls (participants without SCI).
• We partitioned SCI data set into five time bins based on years post-SCI: – 0–0.5, >0.5–1, >1–2, >2–4, and >4.
This article and any supplementary material should be cited as follows: Dudley-Javoroski S, Shields RK. Regional cortical and trabecular bone loss after spinal cord injury. J Rehabil Res Dev. 2012;49(9):1365-76. http://dx.doi.org/10.1682/JRRD.2011.12.0245
Slideshow ProjectDOI:10.1682/JRRD.2011.12.0245JSP
Results
• BMD:– 1 year post-SCI, 15% to 35% of BMD was lost at
distal femur, proximal tibia, and distal fibula.– Bone loss at distal fibula accelerated between 1 and
2 years post-SCI. – BMD at these sites reached steady state value of
~50% of non-SCI value 4 years post-SCI.
• Cortical CSA:– At tibia diaphysis, decline was slower, eventually
reaching 65% of non-SCI value.
This article and any supplementary material should be cited as follows: Dudley-Javoroski S, Shields RK. Regional cortical and trabecular bone loss after spinal cord injury. J Rehabil Res Dev. 2012;49(9):1365-76. http://dx.doi.org/10.1682/JRRD.2011.12.0245
Slideshow ProjectDOI:10.1682/JRRD.2011.12.0245JSP
Results
Representative peripheral quantitative computed tomography images for participant with and participant without SCI.
This article and any supplementary material should be cited as follows: Dudley-Javoroski S, Shields RK. Regional cortical and trabecular bone loss after spinal cord injury. J Rehabil Res Dev. 2012;49(9):1365-76. http://dx.doi.org/10.1682/JRRD.2011.12.0245
Slideshow ProjectDOI:10.1682/JRRD.2011.12.0245JSP
Conclusion• Because of extensive loss of bone observed at
these sites, careful consideration needs to be given to dose of musculoskeletal stress delivered during rehabilitation interventions like standing, muscle electrical stimulation, and aggressive stretching of spastic muscles.
• Mechanical loading interventions that begin early after SCI, when BMD is nearly normal, may offer greater safety and efficacy than after chronic SCI.