Early identification of patients with rapid bone loss following spinal cord injury, using peripheral Quantitative Computed Tomography (pQCT)

Sylvie Coupaud, Alan N. McLean, David B. Allan

Research output: Contribution to journalConference Contribution

Abstract

Objectives: We are developing bone densitometry protocols to identify patients with significant bone loss early after spinal cord injury (SCI), to enable targeted treatment against osteoporosis. Fragility fracture rates in the paralysed limbs are high [1] at the trabecular-rich sites that show the most rapid and extensive bone loss after SCI [2,3].

Material & Methods: Inpatients of the Queen Elizabeth National Spinal Injuries Unit (Glasgow, UK) with motor-complete SCI at neurological levels C4 and below are scanned using peripheral Quantitative Computed Tomography (pQCT) within 5 weeks of injury (Baseline), and again at 4, 8 and 12 months post-SCI. Total Bone Mineral Density (BMDtot), trabecular BMD (BMDtrab) and bone mineral content (BMC) are calculated from unilateral scans at both epiphyses of the tibia, and the distal epiphyses of the femur and radius.

Results: Data are presented from 13 subjects: 8 paraplegia / 5 tetraplegia, all male, aged 17-72 years old. At baseline, mean (SD) BMDtot was 345.70 (24.42), 263.10 (33.21) and 293.10 (24.92) mg/cm3 in the distal tibia, proximal tibia and distal femur, respectively. By 8 months post-injury, BMDtot had fallen to 293.59 (53.34), 202.36 (46.30) and 247.94 (39.72), respectively. Further regression analyses revealed some subjects with statistically significant decreases in BMD and BMC in the paralysed limbs (“FAST” bone losers), others with little/no bone loss (“SLOW” bone losers).

Conclusions: Repeat pQCT bone scans within the first year of SCI enable us to red-flag “FAST” bone losers, providing a window of opportunity to apply preventative treatments against further bone loss in vulnerable patients. These data will inform osteoporosis management in SCI and other patient groups.

References: [1] Vestergaard P. et al. (1998) Spinal Cord 36(11): 790-796; [2] Morse L. et.al. (2009) Osteoporos Int 20: 385-392; [3] Eser P. et al. (2005) Arch Phys Med Rehabil 86: 498-504.
LanguageEnglish
Article numberP296
PagesS179-S180
Number of pages2
JournalOsteoporosis International
Volume23
Issue numberIssue 2 Supplement
DOIs
Publication statusPublished - 1 Mar 2012
EventIOF-ECCEO European Congress on Osteoporosis & Osteoarthritis - Bordeaux, France
Duration: 21 Mar 201224 Mar 2012

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Spinal Cord Injuries
Tomography
Bone
Bone and Bones
Tibia
Bone Density
Epiphyses
Femur
Osteoporosis
Minerals
Extremities
Spinal Injuries
Quadriplegia
Densitometry
Paraplegia
Wounds and Injuries
Inpatients
Spinal Cord
Arches
Regression Analysis

Keywords

  • osteoporosis
  • spinal cord injury
  • pQCT
  • bone scans
  • bone mineral density

Cite this

@article{036000fcd05240d3a404c64fcfe0f64e,
title = "Early identification of patients with rapid bone loss following spinal cord injury, using peripheral Quantitative Computed Tomography (pQCT)",
abstract = "Objectives: We are developing bone densitometry protocols to identify patients with significant bone loss early after spinal cord injury (SCI), to enable targeted treatment against osteoporosis. Fragility fracture rates in the paralysed limbs are high [1] at the trabecular-rich sites that show the most rapid and extensive bone loss after SCI [2,3]. Material & Methods: Inpatients of the Queen Elizabeth National Spinal Injuries Unit (Glasgow, UK) with motor-complete SCI at neurological levels C4 and below are scanned using peripheral Quantitative Computed Tomography (pQCT) within 5 weeks of injury (Baseline), and again at 4, 8 and 12 months post-SCI. Total Bone Mineral Density (BMDtot), trabecular BMD (BMDtrab) and bone mineral content (BMC) are calculated from unilateral scans at both epiphyses of the tibia, and the distal epiphyses of the femur and radius. Results: Data are presented from 13 subjects: 8 paraplegia / 5 tetraplegia, all male, aged 17-72 years old. At baseline, mean (SD) BMDtot was 345.70 (24.42), 263.10 (33.21) and 293.10 (24.92) mg/cm3 in the distal tibia, proximal tibia and distal femur, respectively. By 8 months post-injury, BMDtot had fallen to 293.59 (53.34), 202.36 (46.30) and 247.94 (39.72), respectively. Further regression analyses revealed some subjects with statistically significant decreases in BMD and BMC in the paralysed limbs (“FAST” bone losers), others with little/no bone loss (“SLOW” bone losers). Conclusions: Repeat pQCT bone scans within the first year of SCI enable us to red-flag “FAST” bone losers, providing a window of opportunity to apply preventative treatments against further bone loss in vulnerable patients. These data will inform osteoporosis management in SCI and other patient groups.References: [1] Vestergaard P. et al. (1998) Spinal Cord 36(11): 790-796; [2] Morse L. et.al. (2009) Osteoporos Int 20: 385-392; [3] Eser P. et al. (2005) Arch Phys Med Rehabil 86: 498-504.",
keywords = "osteoporosis, spinal cord injury, pQCT, bone scans, bone mineral density",
author = "Sylvie Coupaud and McLean, {Alan N.} and Allan, {David B.}",
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Early identification of patients with rapid bone loss following spinal cord injury, using peripheral Quantitative Computed Tomography (pQCT). / Coupaud, Sylvie; McLean, Alan N.; Allan, David B.

In: Osteoporosis International , Vol. 23, No. Issue 2 Supplement, P296, 01.03.2012, p. S179-S180.

Research output: Contribution to journalConference Contribution

TY - JOUR

T1 - Early identification of patients with rapid bone loss following spinal cord injury, using peripheral Quantitative Computed Tomography (pQCT)

AU - Coupaud, Sylvie

AU - McLean, Alan N.

AU - Allan, David B.

PY - 2012/3/1

Y1 - 2012/3/1

N2 - Objectives: We are developing bone densitometry protocols to identify patients with significant bone loss early after spinal cord injury (SCI), to enable targeted treatment against osteoporosis. Fragility fracture rates in the paralysed limbs are high [1] at the trabecular-rich sites that show the most rapid and extensive bone loss after SCI [2,3]. Material & Methods: Inpatients of the Queen Elizabeth National Spinal Injuries Unit (Glasgow, UK) with motor-complete SCI at neurological levels C4 and below are scanned using peripheral Quantitative Computed Tomography (pQCT) within 5 weeks of injury (Baseline), and again at 4, 8 and 12 months post-SCI. Total Bone Mineral Density (BMDtot), trabecular BMD (BMDtrab) and bone mineral content (BMC) are calculated from unilateral scans at both epiphyses of the tibia, and the distal epiphyses of the femur and radius. Results: Data are presented from 13 subjects: 8 paraplegia / 5 tetraplegia, all male, aged 17-72 years old. At baseline, mean (SD) BMDtot was 345.70 (24.42), 263.10 (33.21) and 293.10 (24.92) mg/cm3 in the distal tibia, proximal tibia and distal femur, respectively. By 8 months post-injury, BMDtot had fallen to 293.59 (53.34), 202.36 (46.30) and 247.94 (39.72), respectively. Further regression analyses revealed some subjects with statistically significant decreases in BMD and BMC in the paralysed limbs (“FAST” bone losers), others with little/no bone loss (“SLOW” bone losers). Conclusions: Repeat pQCT bone scans within the first year of SCI enable us to red-flag “FAST” bone losers, providing a window of opportunity to apply preventative treatments against further bone loss in vulnerable patients. These data will inform osteoporosis management in SCI and other patient groups.References: [1] Vestergaard P. et al. (1998) Spinal Cord 36(11): 790-796; [2] Morse L. et.al. (2009) Osteoporos Int 20: 385-392; [3] Eser P. et al. (2005) Arch Phys Med Rehabil 86: 498-504.

AB - Objectives: We are developing bone densitometry protocols to identify patients with significant bone loss early after spinal cord injury (SCI), to enable targeted treatment against osteoporosis. Fragility fracture rates in the paralysed limbs are high [1] at the trabecular-rich sites that show the most rapid and extensive bone loss after SCI [2,3]. Material & Methods: Inpatients of the Queen Elizabeth National Spinal Injuries Unit (Glasgow, UK) with motor-complete SCI at neurological levels C4 and below are scanned using peripheral Quantitative Computed Tomography (pQCT) within 5 weeks of injury (Baseline), and again at 4, 8 and 12 months post-SCI. Total Bone Mineral Density (BMDtot), trabecular BMD (BMDtrab) and bone mineral content (BMC) are calculated from unilateral scans at both epiphyses of the tibia, and the distal epiphyses of the femur and radius. Results: Data are presented from 13 subjects: 8 paraplegia / 5 tetraplegia, all male, aged 17-72 years old. At baseline, mean (SD) BMDtot was 345.70 (24.42), 263.10 (33.21) and 293.10 (24.92) mg/cm3 in the distal tibia, proximal tibia and distal femur, respectively. By 8 months post-injury, BMDtot had fallen to 293.59 (53.34), 202.36 (46.30) and 247.94 (39.72), respectively. Further regression analyses revealed some subjects with statistically significant decreases in BMD and BMC in the paralysed limbs (“FAST” bone losers), others with little/no bone loss (“SLOW” bone losers). Conclusions: Repeat pQCT bone scans within the first year of SCI enable us to red-flag “FAST” bone losers, providing a window of opportunity to apply preventative treatments against further bone loss in vulnerable patients. These data will inform osteoporosis management in SCI and other patient groups.References: [1] Vestergaard P. et al. (1998) Spinal Cord 36(11): 790-796; [2] Morse L. et.al. (2009) Osteoporos Int 20: 385-392; [3] Eser P. et al. (2005) Arch Phys Med Rehabil 86: 498-504.

KW - osteoporosis

KW - spinal cord injury

KW - pQCT

KW - bone scans

KW - bone mineral density

UR - http://link.springer.com/journal/198

U2 - 10.1007/s00198-012-1928-7

DO - 10.1007/s00198-012-1928-7

M3 - Conference Contribution

VL - 23

SP - S179-S180

JO - Osteoporosis International

T2 - Osteoporosis International

JF - Osteoporosis International

SN - 0937-941X

IS - Issue 2 Supplement

M1 - P296

ER -