Bone Mass and Hormone Analysis in Patients With Spinal Cord Injury:
          Evidence for a Gonadal Axis Disruption

Abstract Context: Bone loss is a constant finding in patients with spinal cord injury (SCI). Objective: We sought to evaluate potential modifiable factors that could lead to bone loss in complete motor paraplegia by examining gonadal axis hormones, vitamin D status, and bone markers. Design: This is a cross sectional. Setting: It includes SCI Outpatient. Patients and other Participants: Twenty-nine chronic male patients with SCI were compared with 17 age-matched, able-bodied men. Main Outcome Measure: The bone mineral density (BMD) of lower limbs and lumbar spine were measured using dual x-ray absorptiometry. Parathormone, 25-hydroxyvitamin D [25(OH)D], collagen type I C-terminal telopeptide (CTX), and sexual hormone were measured. Results: Patients with SCI had lower BMD at the inferior limbs sites. CTX showed an inverse relationship with the time since injury. Patients had lower free T levels (SCI, 12.00 ± 2.91 vs controls, 19.51 ± 5.72; P ≤ .001), and the majority (72%) had normal/low levels of gonadotropins. Low T, however, was not related to low bone mass in patients with SCI. In the controls, the 25(OH)D level was positively correlated with the T and with the lumbar spine BMD, but these correlations were not observed in the SCI. Conclusions: Impairment of testicular function after SCI was indicated by the low levels of T and the loss of correlation between T and 25(OH)D levels; this correlation was present in the able-bodied controls. Inappropriate levels of gonadotropins were identified in most patients, featuring a hypogonadotropic hypogonadism and suggesting a disruption of the pituitary-gonadal axis. T concentrations might not be an effective target for bone loss therapy.

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Dual-energy X-ray absorptiometry overestimates bone mineral density of the lumbar spine in persons with spinal cord injury

Spinal Cord ◽

10.1038/sc.2008.169 ◽

2009 ◽

Vol 47 (8) ◽

pp. 628-633 ◽

Cited By ~ 25

Author(s):

W A Bauman ◽

E Schwartz ◽

I S Y Song ◽

S Kirshblum ◽

C Cirnigliaro ◽

...

Keyword(s):

Bone Mineral Density ◽

Spinal Cord ◽

Spinal Cord Injury ◽

Lumbar Spine ◽

Bone Mineral ◽

Dual Energy ◽

Mineral Density ◽

X Ray ◽

Cord Injury

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Spinal Cord Injury Induced Osteoporosis: Case Report and Current Literature

International Journal of Medical Students ◽

10.5195/ijms.2021.535 ◽

2021 ◽

Vol 9 (2) ◽

pp. 155-159

Author(s):

Abdulai Bangura ◽

Thomas Shuler ◽

Lisa Wright ◽

Anne Lake

Keyword(s):

Bone Mineral Density ◽

Spinal Cord ◽

Spinal Cord Injury ◽

Bone Loss ◽

Bone Mineral ◽

Treatment Plan ◽

Treatment Options ◽

Definitive Treatment ◽

Mineral Density ◽

Cord Injury

Background: Among the various etiologies of osteoporosis, spinal cord injury has a drastic progression of the disease, causing weekly bone loss. There is no definitive treatment for the prevention of osteoporosis in these individuals. This review illustrates the recent findings on the pathophysiology, treatment, and management of spinal cord injury-induced osteoporosis. Furthermore, we cover a case of a male patient who experienced severe bone loss after a spinal cord injury at the age of 21 years. The Case: We have a 57-year-old man with a history of AIS grade A spinal cord injury, level T11 with rod fixation from a motorcycle collision at age 21. His fracture history following the injury includes tibia, femur, and vertebral fractures. Bone mineral density imaging revealed notable T-scores ranging from -3.1 to -3.4 at the hip and femurs. Treatment plan consisted of teriparatide, dietary supplements, and physical therapy. Biomarkers from baseline to post one month of treatment revealed the following: procollagen type 1 N-terminal propeptide from 38 mcg/L to 70 mcg/L and C-terminal telopeptide from 209 pg/mL to 88 pg/mL, representing an increased bone formation and decreased bone resorption, respectively. After two years, bone mineral density T-scores improved to -2.7 on the left and the patient was capable of standing for the first time with the assistance of a standing frame. Conclusion: Our case exemplified the progression of the disease and treatment options. A basis for the derivation of future innovative therapies has been covered. Favorable treatments and management are described in the review.

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The Effects of Exercise and Activity-Based Physical Therapy on Bone after Spinal Cord Injury

International Journal of Molecular Sciences ◽

10.3390/ijms23020608 ◽

2022 ◽

Vol 23 (2) ◽

pp. 608

Author(s):

Tommy W. Sutor ◽

Jayachandra Kura ◽

Alex J. Mattingly ◽

Dana M. Otzel ◽

Joshua F. Yarrow

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Physical Therapy ◽

Bone Loss ◽

Molecular Mechanisms ◽

Weight Bearing ◽

Mineral Density ◽

Partial Weight Bearing ◽

Cord Injury ◽

Partial Weight

Spinal cord injury (SCI) produces paralysis and a unique form of neurogenic disuse osteoporosis that dramatically increases fracture risk at the distal femur and proximal tibia. This bone loss is driven by heightened bone resorption and near-absent bone formation during the acute post-SCI recovery phase and by a more traditional high-turnover osteopenia that emerges more chronically, which is likely influenced by the continual neural impairment and musculoskeletal unloading. These observations have stimulated interest in specialized exercise or activity-based physical therapy (ABPT) modalities (e.g., neuromuscular or functional electrical stimulation cycling, rowing, or resistance training, as well as other standing, walking, or partial weight-bearing interventions) that reload the paralyzed limbs and promote muscle recovery and use-dependent neuroplasticity. However, only sparse and relatively inconsistent evidence supports the ability of these physical rehabilitation regimens to influence bone metabolism or to increase bone mineral density (BMD) at the most fracture-prone sites in persons with severe SCI. This review discusses the pathophysiology and cellular/molecular mechanisms that influence bone loss after SCI, describes studies evaluating bone turnover and BMD responses to ABPTs during acute versus chronic SCI, identifies factors that may impact the bone responses to ABPT, and provides recommendations to optimize ABPTs for bone recovery.

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The Effect of Bisphosphonates on Managing Osteoporosis After Spinal Cord Injury: A Meta-Analysis

Current Pharmaceutical Design ◽

10.2174/1381612826666200504115747 ◽

2020 ◽

Vol 26 (39) ◽

pp. 5072-5078

Author(s):

Ji Xinghua ◽

Wang Junjie ◽

Guo Yao ◽

Shang Peng ◽

Huo Jianzhong

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Lumbar Spine ◽

Bone Loss ◽

Bone Turnover Marker ◽

Fragility Fractures ◽

Prevent Bone Loss ◽

Cord Injury ◽

Time Point

Background: The increased bone loss after spinal cord injury (SCI) is associated with an increase in the morbidity and mortality of fragility fractures, which can constitute a substantial cost to health care systems. Bisphosphonates (BPs) are now the principal class of medications used for osteoporosis. Objective: To demonstrate the effect of BPs on treating osteoporosis after SCI. Methods: A comprehensive search in PubMed, EMBASE, Web of Science and Cochrane Central databases was undertaken for randomized controlled trials (RCTs), exploring the effect of BPs on osteoporosis after SCI. The primary outcome measures were the BMD of different locations, serum bone turnover marker levels, serum biochemistry marker levels and adverse effect (AE) risks. The final search was performed in September 2019. Reporting was carried out according to PRISMA Guidelines. Results: Six RCTs were included. A total of 147 patients met the inclusion criteria. BPs were found to statistically prevent bone loss in the total hip, femoral neck and trochanter at the 6- and 12-month follow-up points and to increase the BMD of the lumbar spine at the 12-month follow-up time point. BPs had no clear effect on serum PINP or serum calcium levels at the 12-month follow-up time point. Conclusion: BP therapy may prevent bone loss in the lumbar spine and hip when administered early after SCI and has relatively high safety.

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