Effect of chronic activity-based therapy on bone mineral density and bone turnover in persons with spinal cord injury
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ORIGINAL ARTICLE
Effect of chronic activity‑based therapy on bone mineral density and bone turnover in persons with spinal cord injury Todd Anthony Astorino · Eric T. Harness · Kara A. Witzke
Received: 12 June 2013 / Accepted: 24 September 2013 / Published online: 6 October 2013 © Springer-Verlag Berlin Heidelberg 2013
Abstract Purpose Osteoporosis is a severe complication of spinal cord injury (SCI). Many exercise modalities are used to slow bone loss, yet their efficacy is equivocal. This study examined the effect of activity-based therapy (ABT) targeting the lower extremities on bone health in individuals with SCI. Methods Thirteen men and women with SCI (age and injury duration = 29.7 ± 7.8 and 1.9 ± 2.7 years) underwent 6 months of ABT. At baseline and after 3 and 6 months of training, blood samples were obtained to assess bone formation (serum procollagen type 1 N propeptide (PINP) and bone resorption (serum C-terminal telopeptide of type I collagen (CTX), and participants underwent dualenergy X-ray absorptiometry scans to obtain total body and regional estimates of bone mineral density (BMD). Results Results demonstrated significant increases (p 0.05) with training. Conclusions Chronic activity-based therapy did not reverse bone loss typically observed soon after injury, yet reductions in BMD were less than the expected magnitude of decline in lower extremity BMD in persons with recent SCI. Keywords Osteoporosis · Paralysis · Exercise training · Bone turnover · Bone mineral density · Spinal cord injury Abbreviations ABT Activity based therapy BMC Bone mineral content BMD Bone mineral density C Cervical CTX Serum C-terminal telopeptide of type I collagen DXA Dual-energy X-ray absorptiometry FES Functional electrical stimulation L Lumbar PINP Procollagen type 1 N propeptide SCI Spinal cord injury
Introduction A serious complication of spinal cord injury (SCI) is marked reductions in bone mineral density (BMD) in the initial 6 months post-injury (Garland et al. 2001) which is greatest in weight-bearing sites such as the tibia and femur (Dauty et al. 2000). Bone loss enhances fracture onset, causing severe clinical, psychological, and financial complications. Therefore, early intervention to slow bone loss,
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reduce fracture risk, and improve health status in individuals with SCI is essential. Many exercise modes have been used to slow bone loss, yet their efficacy is equivocal. For example, previous studies (Belanger et al. 2000; Chen et al. 2005) conducted in persons with chronic SCI varying in injury severity revealed increased BMD at the knee after 6 months of functional electrical stimulation exercise (FES) performed 2.5–5.0 h/ week. Similar enhancements in BMD were also revealed in individuals completing FES (Mohr et al. 1997; Frotzler et al. 2008) as well as body weight supported-treadmill training (Coupaud et al. 2009). In contrast, other investigations using these modalities of exercise demonstrated a maintenance (Eser et al. 2003; Giangregorio et al. 2006) or reduced BMD (F
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