Osteoporosis After a Spinal Cord Injury Birgitte Hansen Clinic of Spinal Cord Injury Hornbæk -...
-
Upload
dorothy-farwell -
Category
Documents
-
view
223 -
download
1
Transcript of Osteoporosis After a Spinal Cord Injury Birgitte Hansen Clinic of Spinal Cord Injury Hornbæk -...
Osteoporosis After a Spinal Cord Injury
Birgitte HansenClinic of Spinal Cord Injury
Hornbæk - Denmark
Osteoporosis results from reduced bone mass
disruption of the micro-architecture of bone,
decreased bone strength
increased risk of fracture.
A Spinal Cord Injury Has
Increase in bone resorption Hormonal alternations Modification of body composition
Wide-ranging physiological and pathological effects
1% - 46% incidence of lower extremity fractures in people who sustain an SCI
Risk Factors For Osteoporosis in SCI Individuals Completeness Low BMI (< 25 kg/m2) Age
Gender (female) Age at injury ( < 18 years) Duration of injury
Bone Evaluation - DXA
•Non pharmacological treatment
•Pharmacologic Therapy
Non pharmacological treatment
MES (muscular electrical stimulation) FES cycle ergometry (functional electrical
stimulation) Standing Walking Teach safe transferring skills
Passive standing do not maintain or improve BMD in the hip or knee regionKunkel et al (Arch Phys Med Rehabil) 1993
Needham-Shropshire et al. (Arch Phys Med Rehabil) 1997
FES cycle ergometry
Conflicting results for bone parameters for six studies
MES –FES assisted training Belanger et al (Arch Phys Med Rehabil
2000) 14 men and women with SCI and 14 controls 5 days/week, 24 weeks
Results BMD regained almost 30 % of lost bone mass
compared to controls
Pharmacologic Therapy Calcium – just supplement Vitamin D – just supplement Calcitonin – optimal dosage and long-term
effectiveness unclear
Vitamin D analog (Etalpha®) – Increase in lower-limb BMD
Bisphosphonates - reduction in bone loss
Vitamin D Analog Treatment
19 subjects had 1-α-D2 4 μg/day for 24 months (21 placebo)
Leg BMD increased significantly from baseline in the treatment group at 12, 18 and 24 months.
Smoking prevents bone effect with 1-α-D2 - reason unclear
Both groups received calcium (1.3 g/d) and vitamin D (800 IU/d)
Conclusion – Vitamin D Analog
Treatment of 1-α-D2 increased lower-limb BMD Current smokers had not this effect Long-term effect of continued 1-α-D2 therapy in
persons with chronic SCI requires further investigation
Bisphosphonates + 1-α-D2 or 1-α-D2 followed by bisphosphonates should be investigated
1-α-D2 + physical intervention may be considered
Bisphosphonates treatment
• First-generation
• Etidronate, clodronate
• Second-generation
• Pamidronate
• Third-generation
• Alendronate, ibandronate, risedronate, tiludronate and zolendronic acid
Treatment With Bisphosphonates
Oral bisphosphonates must be Ingested on an empty stomach With 150-200 ml water Followed by sitting up for 1 hour prior to
taking any other food or medication Side effects
Joint pain Stomach upset/gastric ulcer
Treatment With Bisphosphonates II Intravenous bisphosphonates
Available in daily, monthly, quarterly and yearly preparations
Assured compliance Reduced relative risk of gastric ulcer
Side effects Fever and muscle pain (flu-like symptoms) Low serum calcium
Clodronate P. Minaire et al. (J. Clin. Invest. 1981)
14 had clodronate (2 different doses), 7 placebo (17 males, 4 females)
Started 17.6 days after injury. 3.5 months of treatment – total 6 months study
Results No decrease in hip and knee region on bone
mineral content in the treated groups
Etidronate and Tiludronate have positive results for treatment within the 1 year of injury
Alendronate Y. Zehnder et al. (JBMR, 2004)
33 men had Aln + Ca, 32 men had Ca in 2 years
9.8 years since SCI Results
BMD in distal and proximal tibia, and total hip remained stable in the Aln – Ca group and decreased in the Ca group
Future Prospects Large prospective longitudinal studies DXA methods to target areas Reducing the risk of falls Osteoprotegerin/RANKL system
Questions to be answered Who When How – and how long to treat?
• Osteoporosis Research Centre, Hvidovre Hospital
Ulla PedersenAnne-Mette RasmussenSolveig PetersenJenni TeilmannOle Helmer SørensenJens-Erik Bech Jensen
• Clinic For Spinal Cord Injury, Rigshospitalet
Lisbeth NielsenFin Biering-Sørensen
Thank you for your attention