Bone turnover markers and parameters of functional and structural state in patients with chronic spinal cord injuries in 5 years and later after the trauma
Keywords:spinal cord injury, osteoporosis, tetraplegia, paraplegia, bone turnover markers, ultrasound densitometry
AbstractBackground. The increased life expectancy of persons with complete spinal cord injury brings into focus the late complications of spinal cord injuries (SCI) including osteoporosis. Purpose of the study was to evaluate the bone mineral status and bone turnover markers in patients with chronic spinal cord injury of 5 years and over. Materials and methods. Seventy-three subjects who suffered from complete spinal cord injury with tetra- or paraplegia and 57 healthy persons were examined. Bone status was determined by ultrasound (US) densitometry of the calcaneal bone using quantitative ultrasonometer Sahara (Hologic Inc., model 04874, 2008). Bone turnover markers in the peripheral blood (osteocalcin, procollagen type 1 propeptide (P1NP), collagen type 1 cross-linked C-telopeptide (β-CTx)) and vitamin D were defined by electrochemiluminescence method. Results. SCI patients demonstrated significantly lower parameters of bone mineral status compared with the subjects of the control group. The stiffness index (SI) was 51.4 ± 11.8 % vs. 98.5 ± 16.6 % (p < 0.05) in men and 50.1 ± 9.8 % vs. 92 9 ± 11.1 % (p < 0.05) in women. There was significant reduction of bone mass index in SCI patients and in the individuals of the control group after 2 years, but bone loss over time was significantly worse in SCI patients (–16.5 ± 2.4 % vs. –2.5 ± 0.9 %, respectively; p < 0.05). In SCI patients levels of bone turnover markers were significantly higher than the relative values in Ukrainian population. Conclusions. SCI with complete spinal cord injury leads to increased bone resorption with formation of secondary osteoporosis (according to the data of ultrasound densitometry of the calcaneal bone). In the late posttraumatic period bone destruction processes are slowing down but remain higher than in the population as a whole, combined with low levels of vitamin D and absence of axial load results in continued loss of trabecular bone mass.
Vaida VM. (Donetsk National Medical University). Gendernі j vіkovі osoblivostі osteoporozu ta jogo uskladnen [Gender and age features of osteoporosis and its complications]. Donetsk; 2011. 310 p. (In Ukrainian).
Povoroznyuk VV. Zahvorjuvannja kіstkovo-m’jazovoї sistemi v ljudej rіznogo vіku (vibranі lekcії, ogljadi, stattі) [Musculo-skeletal disorders in patients of different age (selected lectures, reviews, articles)]. Kyiv; 2009. 3 vol. (In Ukrainian).
Battaglino R, Lazzari A, Garshick E, Morse L. Spinal cord injury-induced osteoporosis: pathogenesis and emerging therapies. Curr Osteoporos Rep. 2012 Dec;10(4):278-85. doi: 10.1007%2Fs11914-012-0117-0.
Bittar C, Cliquet A. Utility of quantitative ultrasound of the calcaneus in diagnosing osteoporosis in spinal cord injury patients. American Journal of Physical Medicine & Rehabilitation. 2011 Jun;90(6):477-81. PMID: 21765270. doi: 10.1097/PHM.0b013e31821a7386.
Chow YW, Inman C, Pollintine P, Sharp CA, et al. Ultrasound bone densitometry and dual energy X-ray absorptiometry in patients with spinal cord injury: a cross-sectional study. Spinal Cord. 1996;34:736-41. doi: 10.1038/sc.1996.134.
Cosman F, de Beur SJ, LeBoff MS, et al. Clinician’s Guide to Prevention and Treatment of Osteoporosis. Osteoporos Int. 2014 Oct;25(10):2359-81. PMID: 25182228. PMCID: PMC4176573. doi: 10.1007/s00198-014-2794-2.
Frotzler A, Berger M, Knecht H, Eser P. Bone steady-state is established at reduced bone strength after spinal cord injury: a longitudinal study using peripheral quantitative computed tomography (pQCT). Bone. 2008;43:549-55. PMID: 18567554. doi: 10.1016/j.bone.2008.05.006.
How to Cite
Copyright (c) 2017 M.A. Bystrytska, V.V. Povoroznyuk
This work is licensed under a Creative Commons Attribution 4.0 International License.