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Hook MA, Falck A, Dundumulla R, Terminel M, Cunningham R, Sefiani A, Callaway K, Gaddy D, Geoffroy CG. Osteopenia in a Mouse Model of Spinal Cord Injury: Effects of Age, Sex and Motor Function. BIOLOGY 2022; 11:biology11020189. [PMID: 35205056 PMCID: PMC8869334 DOI: 10.3390/biology11020189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 01/20/2022] [Accepted: 01/22/2022] [Indexed: 11/16/2022]
Abstract
Simple Summary In the first two years following spinal cord injury, people lose up to 50% of bone below the injury. This injury-induced bone loss significantly affects rehabilitation and leaves people vulnerable to fractures and post-fracture complications, including lung and urinary tract infections, blood clots in the veins, and depression. Unfortunately, little is known about the factors driving this bone loss. In fact, even though we know that injury, age, and sex independently increase bone loss, there have been no studies looking at the cumulative effects of these variables. People with spinal injury are aging, and the age at which injuries occur is increasing. It is essential to know whether these factors together will further compromise bone. To examine this, we assessed bone loss in young and old, male and female mice after spinal injury. As expected, we found that aging alone decreased motor activity and bone volume. Spinal injury also reduced bone volume, but it did not worsen the effects of age. Instead, injury effects appeared related to reduced rearing activity. The data suggest that although partial weight-bearing does not reduce bone loss after spinal cord injury, therapies that put full weight on the legs may be clinically effective. Abstract After spinal cord injury (SCI), 80% of individuals are diagnosed with osteopenia or osteoporosis. The dramatic loss of bone after SCI increases the potential for fractures 100-fold, with post-fracture complications occurring in 54% of cases. With the age of new SCI injuries increasing, we hypothesized that a SCI-induced reduction in weight bearing could further exacerbate age-induced bone loss. To test this, young (2–3 months) and old (20–30 months) male and female mice were given a moderate spinal contusion injury (T9–T10), and recovery was assessed for 28 days (BMS, rearing counts, distance traveled). Tibial trabecular bone volume was measured after 28 days with ex vivo microCT. While BMS scores did not differ across groups, older subjects travelled less in the open field and there was a decrease in rearing with age and SCI. As expected, aging decreased trabecular bone volume and cortical thickness in both old male and female mice. SCI alone also reduced trabecular bone volume in young mice, but did not have an additional effect beyond the age-dependent decrease in trabecular and cortical bone volume seen in both sexes. Interestingly, both rearing and total activity correlated with decreased bone volume. These data underscore the importance of load and use on bone mass. While partial weight-bearing does not stabilize/reverse bone loss in humans, our data suggest that therapies that simulate complete loading may be effective after SCI.
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Affiliation(s)
- Michelle A. Hook
- Department of Neuroscience and Experimental Therapeutics, College of Medicine, Texas A&M Health Science Center, Bryan, TX 77807, USA; (R.D.); (M.T.); (R.C.); (A.S.); (K.C.); (C.G.G.)
- Correspondence: ; Tel.: +1-979-436-0568
| | - Alyssa Falck
- Veterinary Integrative Biosciences, College of Veterinary Medicine and Biomedical Sciences, College Station, TX 77843, USA; (A.F.); (D.G.)
| | - Ravali Dundumulla
- Department of Neuroscience and Experimental Therapeutics, College of Medicine, Texas A&M Health Science Center, Bryan, TX 77807, USA; (R.D.); (M.T.); (R.C.); (A.S.); (K.C.); (C.G.G.)
| | - Mabel Terminel
- Department of Neuroscience and Experimental Therapeutics, College of Medicine, Texas A&M Health Science Center, Bryan, TX 77807, USA; (R.D.); (M.T.); (R.C.); (A.S.); (K.C.); (C.G.G.)
| | - Rachel Cunningham
- Department of Neuroscience and Experimental Therapeutics, College of Medicine, Texas A&M Health Science Center, Bryan, TX 77807, USA; (R.D.); (M.T.); (R.C.); (A.S.); (K.C.); (C.G.G.)
| | - Arthur Sefiani
- Department of Neuroscience and Experimental Therapeutics, College of Medicine, Texas A&M Health Science Center, Bryan, TX 77807, USA; (R.D.); (M.T.); (R.C.); (A.S.); (K.C.); (C.G.G.)
| | - Kayla Callaway
- Department of Neuroscience and Experimental Therapeutics, College of Medicine, Texas A&M Health Science Center, Bryan, TX 77807, USA; (R.D.); (M.T.); (R.C.); (A.S.); (K.C.); (C.G.G.)
| | - Dana Gaddy
- Veterinary Integrative Biosciences, College of Veterinary Medicine and Biomedical Sciences, College Station, TX 77843, USA; (A.F.); (D.G.)
| | - Cédric G. Geoffroy
- Department of Neuroscience and Experimental Therapeutics, College of Medicine, Texas A&M Health Science Center, Bryan, TX 77807, USA; (R.D.); (M.T.); (R.C.); (A.S.); (K.C.); (C.G.G.)
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Park A, Anderson D, Battaglino RA, Nguyen N, Morse LR. Ibuprofen use is associated with reduced C-reactive protein and interleukin-6 levels in chronic spinal cord injury. J Spinal Cord Med 2022; 45:117-125. [PMID: 32496940 PMCID: PMC8890558 DOI: 10.1080/10790268.2020.1773029] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Objective: To assess the association between ibuprofen use and the systemic inflammatory biomarkers C-reactive protein (CRP) and interleukin-6 (IL-6) in chronic Spinal Cord Injury (SCI).Study design: Prospective cohort study.Setting: Community dwelling individuals with SCI.Participants: 338 (278 male, 60 female) community dwelling individuals with chronic SCI (≥1-year post-injury).Interventions: None.Main outcome measures: CRP and IL-6 levels were quantified by ultra-sensitive ELISA assay. General linear models were used to assess associations between various clinical and demographic factors and CRP and IL-6 levels.Results: There were 50 active ibuprofen users and 288 non-users. After adjusting for clinical and demographic factors, ibuprofen users had significantly lower CRP levels (2.3 mg/L versus 3.5 mg/L, P = 0.04) and IL-6 levels (3.2 pg/ml versus 4.0 pg/ml, P = 0.04) compared to nonusers.Conclusions: Our study suggests that self-reported ibuprofen use may be negatively associated with CRP and IL-6 levels in chronic SCI after adjusting for known confounding factors, and suggests ibuprofen use may be an important, potential variable to consider in future studies focused on systemic inflammation in SCI. Future prospective studies require assessing frequency, duration, and dosage-dependent effects of ibuprofen on systemic markers of inflammation in chronic SCI. These findings may support future clinical trials to determine safety and efficacy of ibuprofen treatment for various outcomes in chronic SCI.
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Affiliation(s)
- Andrew Park
- Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Dustin Anderson
- Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Ricardo A. Battaglino
- Department of Rehabilitation Medicine, University of Minnesota School of Medicine, Minneapolis, Minnesota, USA
| | - Nguyen Nguyen
- Department of Rehabilitation Medicine, University of Minnesota School of Medicine, Minneapolis, Minnesota, USA
| | - Leslie R. Morse
- Department of Rehabilitation Medicine, University of Minnesota School of Medicine, Minneapolis, Minnesota, USA,Correspondence to: Leslie R. Morse, Department of Rehabilitation Medicine, University of Minnesota Medical School, 500 Boynton Health Service Bridge, 410 Church St. SE, Minneapolis, MN55455, USA; Ph: 612-301-2163, F: 612-624-6686.
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El-Kotob R, Craven BC, Thabane L, Papaioannou A, Adachi JD, Giangregorio LM. Exploring changes in bone mass in individuals with a chronic spinal cord injury. Osteoporos Int 2021; 32:759-767. [PMID: 33089353 DOI: 10.1007/s00198-020-05705-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 10/16/2020] [Indexed: 12/28/2022]
Abstract
UNLABELLED People experience rapid bone loss shortly after a spinal cord injury (SCI), but the long-term bone changes are yet to be confirmed. This study showed that trabecular bone may have reached a steady state, whereas cortical bone continued to decline in people with a chronic SCI (mean time post injury: 15.5 ± 10 years). INTRODUCTION (1) To explore changes in bone [primary measure: trabecular volumetric bone mineral density (vBMD); secondary measures: cortical vBMD, cortical thickness, cortical cross-sectional area (CSA), and polar moment of inertia] over 2 years in individuals with a chronic spinal cord injury (SCI). (2) To explore whether muscle density changes were potential correlates of the observed bone changes. METHODS This study is a secondary data analysis of a prospective, observational study involving 70 people with a chronic SCI (≥ 2 years post injury). The study included 4 strata of participants with diverse impairments: (1) Paraplegia (T1-T12) motor complete American Spinal Injury Association Impairment Scale (AIS) A/B (n = 23), (2) Paraplegia motor incomplete AIS C/D (n = 11), (3) Tetraplegia (C2-C8) AIS A/B (n = 22), and (4) Tetraplegia AIS C/D (n = 14). Peripheral quantitative computed tomography scans were taken at the 4% (distal tibia), 38% (diaphyseal tibia), and 66% (muscle cross-sectional area) tibia sites by measuring from the distal to proximal tibia starting at the inferior border of the medial malleolus. The tibia sites were assessed annually over a span of 2 years. Comparisons were made using a paired-samples t test and simple linear regression was used to adjust for sex, time post injury, and bisphosphonate use. RESULTS We observed no changes in trabecular vBMD at the 4% tibia site, but there was a statistically significant decline in cortical vBMD, cortical thickness, and CSA at the 38% tibia site. Changes in muscle density were not associated with the decreases observed in cortical bone. CONCLUSION Our findings suggest that individuals with chronic SCI (mean duration of injury: 15.5 ± 10 years) may have reached a plateau in bone loss with respect to trabecular bone, but cortical bone loss can continue well into the chronic stages.
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Affiliation(s)
- R El-Kotob
- Deparment of Kinesiology, University of Waterloo, 200 University Ave W, Waterloo, ON, N2L 3G1, Canada.
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, M4G 3V9, Canada.
| | - B C Craven
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, M4G 3V9, Canada
- Department of Medicine, University of Toronto, Toronto, ON, M5S 1A8, Canada
| | - L Thabane
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, L8S 4L8, Canada
| | - A Papaioannou
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, L8S 4L8, Canada
- Department of Medicine, McMaster University, Hamilton, ON, L8S 4L8, Canada
| | - J D Adachi
- Department of Medicine, McMaster University, Hamilton, ON, L8S 4L8, Canada
| | - L M Giangregorio
- Deparment of Kinesiology, University of Waterloo, 200 University Ave W, Waterloo, ON, N2L 3G1, Canada
- Schlegel-University of Waterloo Research Institute for Aging, Waterloo, ON, N2J 0E2, Canada
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Bone Loss and the Current Diagnosis of Osteoporosis and Risk of Fragility Fracture in Persons with Spinal Cord Injury. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2020. [DOI: 10.1007/s40141-020-00268-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Sadowsky CL, Mingioni N, Zinski J. A Primary Care Provider's Guide to Bone Health in Spinal Cord-Related Paralysis. Top Spinal Cord Inj Rehabil 2020; 26:128-133. [PMID: 32760192 PMCID: PMC7384544 DOI: 10.46292/sci2602-128] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Individuals with spinal cord injury/disorder (SCI/D) are at high risk for developing secondary osteoporosis. Bone loss after neurologic injury is multifactorial and is dependent on the time from and extent of neurologic injury. Most bone loss occurs in the first year after complete motor paralysis, and fractures occur most commonly in the distal femur and proximal tibia (paraplegic fracture). The 2019 International Society for Clinical Densitometry Position Statement in SCI establishes that dual-energy X-ray absorptiometry (DXA) can be used to both diagnose osteoporosis and predict lower extremity fracture risk in individuals with SCI/D. Pharmacologic treatments used in primary osteoporosis have mixed results when used for SCI/D-related osteoporosis. Ambulation, standing, and electrical stimulation may be helpful at increasing bone mineral density (BMD) in individuals with SCI/D but do not necessarily correlate with fracture risk reduction. Clinicians caring for individuals with spinal cord-related paralysis must maintain a high index of suspicion for fragility fractures and consider referral for surgical evaluation and management.
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Affiliation(s)
- Cristina L Sadowsky
- International Center for Spinal Cord Injury/Kennedy Krieger Institute, Baltimore, Maryland
- Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Nina Mingioni
- Department of Internal Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Joseph Zinski
- Department of Cell and Developmental Biology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
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Abstract
OBJECTIVE Statins are a class of drugs that competitively bind to the active site of HMG-CoA reductase enzyme, thereby inhibiting the initial steps in cholesterol synthesis. Originally approved for use in lowering serum cholesterol, a risk factor for developing atherosclerosis and coronary heart disease, statins have subsequently been noted to have myriad extrahepatic effects, including potential effects on cognition, diabetes, breast cancer, bone, and muscle. This narrative review assesses the current state of the science regarding the risks and benefits of statin therapy in women to identify areas where additional research is needed. METHODS Basic and clinical studies were identified by searching PubMed with particular attention to inclusion of female animals, women, randomized controlled trials, and sex-specific analyses. RESULTS Statin therapy is generally recommended to reduce the risk of cardiovascular disease. None of the current clinical guidelines, however, offer sex-specific recommendations for women due to lack of understanding of sex differences and underlying mechanisms of disease processes. In addition, conclusions regarding efficacy of treatments do not consider lipid solubility for the drug, dosing, duration of treatment, interactions with estrogen, or comorbidities. Pleiotropic effects of statins are often derived from secondary analysis of studies with cardiovascular events as primary outcomes. CONCLUSIONS Many of the trials that have established the efficacy and safety of statins were conducted predominantly or entirely in men, with results extrapolated to women. Additional research is needed to guide clinical recommendations specific to women. : Video Summary:http://links.lww.com/MENO/A462.
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Affiliation(s)
- Stephanie S. Faubion
- Center for Women’s Health, Mayo Clinic, Rochester, MN
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN
| | - Ekta Kapoor
- Center for Women’s Health, Mayo Clinic, Rochester, MN
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, MN
| | - Ann M. Moyer
- Department of Pathology and Laboratory Medicine, Mayo Clinic, Rochester, MN
| | - Howard N. Hodis
- Atherosclerosis Research Unit, Departments of Medicine and Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Virginia M. Miller
- Departments of Surgery and Physiology & Biomedical Engineering, Women’s Health Research Center, Mayo Clinic, Rochester, MN
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Zleik N, Weaver F, Harmon RL, Le B, Radhakrishnan R, Jirau-Rosaly WD, Craven BC, Raiford M, Hill JN, Etingen B, Guihan M, Heggeness MH, Ray C, Carbone L. Prevention and management of osteoporosis and osteoporotic fractures in persons with a spinal cord injury or disorder: A systematic scoping review. J Spinal Cord Med 2019; 42:735-759. [PMID: 29745791 PMCID: PMC6830234 DOI: 10.1080/10790268.2018.1469808] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Objectives: The primary objective was to review the literature regarding methodologies to assess fracture risk, to prevent and treat osteoporosis and to manage osteoporotic fractures in SCI/D.Study Design: Scoping review.Settings/Participants: Human adult subjects with a SCI/D.Outcome measures: Strategies to identify persons with SCI/D at risk for osteoporotic fractures, nonpharmacological and pharmacological therapies for osteoporosis and management of appendicular fractures.Results: 226 articles were included in the scoping review. Risk of osteoporotic fractures in SCI is predicted by a combination of DXA-defined low BMD plus clinical and demographic characteristics. Screening for secondary causes of osteoporosis, in particular hyperparathyroidism, hyperthyroidism, vitamin D insufficiency and hypogonadism, should be considered. Current antiresorptive therapies for treatment of osteoporosis have limited efficacy. Use of surgery to treat fractures has increased and outcomes are good and comparable to conservative treatment in most cases. A common adverse event following fracture was delayed healing.Conclusions: Most of the research in this area is limited by small sample sizes, weak study designs, and significant variation in populations studied. Future research needs to address cohort definition and study design issues.
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Affiliation(s)
- Nour Zleik
- Charlie Norwood Veterans Administration Medical Center, Augusta, Georgia, USA
- Department of Medicine, Division of Rheumatology, Medical College of Georgia at Augusta University, Augusta, Georgia, USA
| | - Frances Weaver
- Center of Innovation for Complex Chronic Healthcare (CINCCH), Health Services Research & Development, Department of Veterans Affairs, Hines VA Hospital, Hines, Illinois, USA
- Department of Public Health Sciences, Stritch School of Medicine, Loyola University, Maywood, Illinois, USA
| | - Robert L. Harmon
- Charlie Norwood Veterans Administration Medical Center, Augusta, Georgia, USA
| | - Brian Le
- Charlie Norwood Veterans Administration Medical Center, Augusta, Georgia, USA
- Department of Medicine, Division of Rheumatology, Medical College of Georgia at Augusta University, Augusta, Georgia, USA
| | | | - Wanda D. Jirau-Rosaly
- Department of Medicine, Division of Geriatrics, Medical College of Georgia at Augusta University, Augusta, Georgia, USA
| | - B. Catharine Craven
- Department of Medicine, Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, Ontario, Canada
| | - Mattie Raiford
- School of Medicine, Medical College of Georgia at Augusta University, Augusta, Georgia, USA
| | - Jennifer N. Hill
- Department of Public Health Sciences, Stritch School of Medicine, Loyola University, Maywood, Illinois, USA
| | - Bella Etingen
- Center of Innovation for Complex Chronic Healthcare (CINCCH), Health Services Research & Development, Department of Veterans Affairs, Hines VA Hospital, Hines, Illinois, USA
| | - Marylou Guihan
- Center of Innovation for Complex Chronic Healthcare (CINCCH), Health Services Research & Development, Department of Veterans Affairs, Hines VA Hospital, Hines, Illinois, USA
| | - Michael H. Heggeness
- Department of Orthopaedic Surgery, University of Kansas School of Medicine, Wichita, Kansas, USA
| | - Cara Ray
- Center of Innovation for Complex Chronic Healthcare (CINCCH), Health Services Research & Development, Department of Veterans Affairs, Hines VA Hospital, Hines, Illinois, USA
- Department of Public Health Sciences, Stritch School of Medicine, Loyola University, Maywood, Illinois, USA
| | - Laura Carbone
- Charlie Norwood Veterans Administration Medical Center, Augusta, Georgia, USA
- Department of Medicine, Division of Rheumatology, Medical College of Georgia at Augusta University, Augusta, Georgia, USA
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Morse LR, Biering-Soerensen F, Carbone LD, Cervinka T, Cirnigliaro CM, Johnston TE, Liu N, Troy KL, Weaver FM, Shuhart C, Craven BC. Bone Mineral Density Testing in Spinal Cord Injury: 2019 ISCD Official Position. J Clin Densitom 2019; 22:554-566. [PMID: 31501005 DOI: 10.1016/j.jocd.2019.07.012] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 07/29/2019] [Indexed: 02/06/2023]
Abstract
Spinal cord injury (SCI) causes rapid osteoporosis that is most severe below the level of injury. More than half of those with motor complete SCI will experience an osteoporotic fracture at some point following their injury, with most fractures occurring at the distal femur and proximal tibia. These fractures have devastating consequences, including delayed union or nonunion, cellulitis, skin breakdown, lower extremity amputation, and premature death. Maintaining skeletal integrity and preventing fractures is imperative following SCI to fully benefit from future advances in paralysis cure research and robotic-exoskeletons, brain computer interfaces and other evolving technologies. Clinical care has been previously limited by the lack of consensus derived guidelines or standards regarding dual-energy X-ray absorptiometry-based diagnosis of osteoporosis, fracture risk prediction, or monitoring response to therapies. The International Society of Clinical Densitometry convened a task force to establish Official Positions for bone density assessment by dual-energy X-ray absorptiometry in individuals with SCI of traumatic or nontraumatic etiology. This task force conducted a series of systematic reviews to guide the development of evidence-based position statements that were reviewed by an expert panel at the 2019 Position Development Conference in Kuala Lumpur, Malaysia. The resulting the International Society of Clinical Densitometry Official Positions are intended to inform clinical care and guide the diagnosis of osteoporosis as well as fracture risk management of osteoporosis following SCI.
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Affiliation(s)
- Leslie R Morse
- Department of Rehabilitation Medicine, University of Minnesota School of Medicine, Minneapolis, MN, USA.
| | - Fin Biering-Soerensen
- Clinic for Spinal Cord Injuries, Neuroscience Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Laura D Carbone
- Charlie Norwood Veterans Affairs Medical Center, Augusta, GA, USA; Department of Medicine, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Tomas Cervinka
- Department of Physiotherapy and Rehabilitation, Faculty of Health and Welfare, Satakunta University of Applied Sciences, Pori, Finland
| | - Christopher M Cirnigliaro
- Department of Veterans Affairs Rehabilitation Research & Development Service National Center for the Medical Consequences of Spinal Cord Injury, James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA
| | - Therese E Johnston
- Department of Physical Therapy, Jefferson College of Rehabilitation Sciences, Thomas Jefferson University, Philadelphia, PA
| | - Nan Liu
- Department of Rehabilitation Medicine and Osteoporosis and Metabolic Bone Disease Center, Peking University Third Hospital, Beijing, China
| | - Karen L Troy
- Department of Biomedical Engineering, Worcester Polytechnic Institute, Worcester, MA, USA
| | - Frances M Weaver
- Center of Innovation for Complex Chronic Healthcare (CINCCH), Health Services Research & Development, Department of Veterans Affairs, Hines VA Hospital, Hines, IL, USA; Department of Public Health Sciences, Stritch School of Medicine, Loyola University, Maywood, IL, USA
| | - Christopher Shuhart
- Swedish Bone Health and Osteoporosis Center, Swedish Medical Group, Seattle WA, USA
| | - Beverley C Craven
- Neural Engineering and Therapeutics Team, KITE Research Institute - University Health Network, Department of Medicine, University of Toronto, Toronto, Ontario Canada
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Draghici AE, Taylor JA, Bouxsein ML, Shefelbine SJ. Effects of FES-Rowing Exercise on the Time-Dependent Changes in Bone Microarchitecture After Spinal Cord Injury: A Cross-Sectional Investigation. JBMR Plus 2019; 3:e10200. [PMID: 31667456 PMCID: PMC6808228 DOI: 10.1002/jbm4.10200] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 04/01/2019] [Accepted: 04/22/2019] [Indexed: 01/21/2023] Open
Abstract
Disuse osteoporosis is a serious, secondary consequence of spinal cord injury (SCI). Numerous pharmacological and exercise therapies have been implemented to mitigate bone loss after SCI. However, these therapies have not been shown to improve bone density, potentially because of insufficient duration and magnitude of loading and/or inability of imaging modalities to capture changes in bone microarchitecture. In this cross‐sectional study, we evaluated bone microstructure of the distal tibia and radius using HR‐pQCT in men with SCI (N = 13) who regularly trained with functional electrical stimulation‐ (FES‐) rowing. We aimed to determine whether the amount of FES‐rowing (total distance rowed and peak foot force) and/or time since injury (TSI) predict bone loss after SCI. We assessed volumetric density of the total, cortical, and trabecular compartments, cortical thickness, and trabecular thickness. Using linear regression analysis, we found that TSI was not associated with any of the tibial bone metrics. In fact, none of the variables (TSI, total distance rowed, and peak foot force) independently predicted bone loss. Using stepwise regression, when all three variables were considered together, we found a strong prediction for trabecular microstructure (trabecular vBMD: R2 = 0.53; p = 0.06; trabecular thickness: R2 = 0.72; p < 0.01), but not cortical bone metrics. In particular, trabecular vBMD and thickness were negatively associated with TSI and positively associated with distance rowed. Foot force contributed markedly less to trabecular bone than distance rowed or TSI. Our results suggest that regular FES‐rowing may have the capacity to alter the time‐dependent bone negative effects of SCI on trabecular bone density and microstructure. © 2019 The Authors. JBMR Plus published by Wiley Periodicals, Inc. on behalf of the American Society for Bone and Mineral Research.
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Affiliation(s)
- Adina E Draghici
- Department of Bioengineering Northeastern University Boston MA USA.,Cardiovascular Research Laboratory Spaulding Rehabilitation Hospital Boston MA USA.,Department of Physical Medicine and Rehabilitation Harvard Medical School Boston MA USA
| | - J Andrew Taylor
- Cardiovascular Research Laboratory Spaulding Rehabilitation Hospital Boston MA USA.,Department of Physical Medicine and Rehabilitation Harvard Medical School Boston MA USA
| | - Mary L Bouxsein
- Endocrine Unit Massachusetts General Hospital and Harvard Medical School Boston MA USA.,Center for Advanced Orthopaedic Studies Beth Israel Deaconess Medical Center Boston MA USA
| | - Sandra J Shefelbine
- Department of Bioengineering Northeastern University Boston MA USA.,Department of Mechanical and Industrial Engineering Northeastern University Boston MA USA
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Mohammad S, Nguyen H, Nguyen M, Abdel-Rasoul M, Nguyen V, Nguyen C, Nguyen K, Li L, Kitzmiller J. Pleiotropic Effects of Statins: Untapped Potential for Statin Pharmacotherapy. Curr Vasc Pharmacol 2019; 17:239-261. [DOI: 10.2174/1570161116666180723120608] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 02/20/2018] [Accepted: 02/22/2018] [Indexed: 12/15/2022]
Abstract
Background: Statins are effective for primary and secondary prevention of atherosclerotic
cardiovascular disease. They also have systemic anti-inflammatory and immunomodulating properties
suggesting potential utility for improving clinical outcomes for a wide range of diseases. The literature
provides data suggesting benefit in patients with comorbidities associated with contrast-induced nephropathy
(CIN), chronic obstructive pulmonary disease (COPD), pneumonia, head injury, neurological
disease (e.g. Alzheimer’s and Parkinson’s disease), prostate cancer, nuclear cataract and spinal cord
injury. This systematic review evaluates the current evidence supporting the potential benefit of statins
outside their customary role of attenuating cardiovascular risk reduction.
</P><P>
Methods: The electronic databases MEDLINE, EMBASE, and clinicaltrials.gov were searched for studies
published January 2000 - March 2018 reporting comorbidity reduction associated with statin use.
</P><P>
Results: Fifty-eight publications that satisfied our selection criteria (based on the PRISM guidance for
systematic reviews) were selected and included case-control, cohort, cross-sectional and observational
studies as well as systematic reviews and meta-analyses. Ten studies addressed statin use and incidence
of CIN after coronary imaging; 8 addressed statin use in patients with COPD; 14 addressed statin use
and comorbidity reduction associated with head injury and/or a neurological disease disorder; 5 addressed
the association between statin use and nuclear cataract; 9 addressed the association between
statin use and prostate/colorectal cancer; 9 studies addressed the role of statin use in treating infections;
and 3 addressed the association between statin use and spinal cord injury related survival rate.
</P><P>
Conclusion: Overall, the literature supports beneficial pleiotropic effects of statin use in contrastinduced
nephropathy, head injury, Alzheimer’s and Parkinson’s disease, nuclear cataract, prostate cancer,
infection management, and spinal cord injury. Further investigation is warranted, and randomized
clinical trials are needed to confirm the clinical utility suggested by the reported studies included in this
meta-analysis.
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Affiliation(s)
- S. Mohammad
- The Ohio State University, College of Medicine, Department of Biological Chemistry and Pharmacology, Columbus, OH 43210, United States
| | - H. Nguyen
- The Ohio State University, College of Medicine, Department of Biological Chemistry and Pharmacology, Columbus, OH 43210, United States
| | - M. Nguyen
- The Ohio State University, College of Medicine, Department of Family Medicine, Columbus, OH 43210, United States
| | - M. Abdel-Rasoul
- The Ohio State University, College of Medicine, Center for Biostatistics, Columbus, OH 43210, United States
| | - V. Nguyen
- The Nguyen Tri Phuong Hospital, Department of Cardiology, HCM City, Vietnam
| | - C.D. Nguyen
- Department of Otolaryngology, The University of Medicine and Pharmacy at Ho Chi Minh City, HCM City, Vietnam
| | - K.T. Nguyen
- Department of Otolaryngology, The University of Medicine and Pharmacy at Ho Chi Minh City, HCM City, Vietnam
| | - L. Li
- Department of Medical Informatics, The Ohio State University, College of Medicine, Columbus, OH 43210, United States
| | - J.P. Kitzmiller
- The Ohio State University, College of Medicine, Department of Biological Chemistry and Pharmacology, Columbus, OH 43210, United States
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Morse LR, Troy KL, Fang Y, Nguyen N, Battaglino R, Goldstein RF, Gupta R, Taylor JA. Combination Therapy With Zoledronic Acid and FES-Row Training Mitigates Bone Loss in Paralyzed Legs: Results of a Randomized Comparative Clinical Trial. JBMR Plus 2019; 3:e10167. [PMID: 31131346 PMCID: PMC6524678 DOI: 10.1002/jbm4.10167] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 12/02/2018] [Accepted: 12/11/2018] [Indexed: 12/11/2022] Open
Abstract
Spinal cord injury (SCI) results in rapid, severe osteoporosis and an increased risk of lower extremity fractures. Despite the medical complications associated with these fractures, there is no standard of care to prevent osteoporotic fractures following SCI. Functional electrical stimulation- (FES-) assisted rowing is a promising intervention to improve bone health in SCI because of its ability to generate a muscular contraction in conjunction with mechanical loading of the lower extremity long bones. Combination therapy consisting of FES-rowing plus zoledronic acid (ZA) may be a superior treatment via inhibition of bone resorption and stimulation of new bone formation. We studied participants enrolled in a randomized clinical trial comparing FES-rowing alone with FES-rowing plus ZA to improve bone health in SCI. Volumetric CT scans at the distal femur and proximal tibial metaphyses were performed. Bone geometric properties (cortical thickness index [CTI], cortical compressive strength index [CSI], buckling ratio [BR], bending strength index) and mineral (cortical bone volume [CBV], cortical bone mineral density, cortical bone mineral content) indices were determined. In models adjusting for baseline values, we found that the CBV (p = 0.05 to 0.006), the CTI (p = 0.009), and the BR (p = 0.001) at both the distal femoral and proximal tibial metaphyses were greater in the ZA plus rowing group compared with the rowing-only group. Similarly, there was a significant positive association between the total rowing work completed and the BR at the proximal tibia (p = 0.05). A subgroup analysis of the rowing-only arm showed that gains in the CSI at the tibial metaphysis varied in a dose-dependent fashion based on the total amount of exercise performed (p = 0.009). These findings demonstrate that the osteogenic response to FES-rowing is dose-dependent. Combination therapy with ZA and FES-row training has therapeutic potential to improve bone quality, and perhaps reduce fracture risk at the most common fracture site following SCI. © 2019 The Authors. JBMR Plus Published by Wiley Periodicals, Inc. on behalf of the American Society for Bone and Mineral Research.
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Affiliation(s)
- L R Morse
- Rocky Mountain Regional Spinal Injury System Craig Rehabilitation Hospital Englewood CO USA.,Department of PMR University of Colorado School of Medicine Aurora CO USA
| | - K L Troy
- Department of Biomedical Engineering Worcester Polytechnic Institute Worcester MA USA
| | - Y Fang
- Department of Biomedical Engineering Worcester Polytechnic Institute Worcester MA USA
| | - N Nguyen
- Rocky Mountain Regional Spinal Injury System Craig Rehabilitation Hospital Englewood CO USA
| | - R Battaglino
- Department of PMR University of Colorado School of Medicine Aurora CO USA
| | - R F Goldstein
- Rocky Mountain Regional Spinal Injury System Craig Rehabilitation Hospital Englewood CO USA
| | - R Gupta
- Department of Radiology Massachusetts General Hospital Boston MA USA
| | - J A Taylor
- Spaulding Rehabilitation Hospital Boston MA USA.,Department of Physical Medicine and Rehabilitation Harvard Medical School Boston MA USA
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12
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Long-term effect of statins on the risk of new-onset osteoporosis: A nationwide population-based cohort study. PLoS One 2018; 13:e0196713. [PMID: 29723231 PMCID: PMC5933736 DOI: 10.1371/journal.pone.0196713] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 04/18/2018] [Indexed: 01/01/2023] Open
Abstract
Background Several observational cohort and meta-analytical studies in humans have shown that statin users have a lower risk of fractures or greater bone mineral densities (BMD) than nonusers. However, some studies including randomized clinical trials have the opposite results, particularly in Asian populations. Objective This study investigates the impacts of statins on new-onset osteoporosis in Taiwan. Methods In a nationwide retrospective population-based cohort study, 45,342 subjects aged between 50–90 years having received statin therapy (statin-users) since January 1 2001, and observed through December 31 2013 were selected from the National Health Insurance Research Database of Taiwan. Likewise, 115,594 patients had no statin therapy (statin-non-users) were included as controls in this study. Multivariable Cox proportional hazards analysis for drug exposures was employed to evaluate the association between statin treatment and new-onset of osteoporosis risk. We also used the long-rank test to evaluate the difference of probability of osteoporosis-free survival. Results During the 13-year follow-up period, 16,146 of all enrolled subjects (10.03%) developed osteoporosis, including 3097 statin-users (6.83%) and 13,049 statin-non-users (11.29%). Overall, statin therapy reduced the risk of new-onset osteoporosis by 48% (adjusted hazard ratio [HR] 0.52; 95% CI 0.50 to 0.54). A dose-response relationship between statin treatment and the risk of new-onset osteoporosis was observed. The adjusted hazard ratios for new-onset osteoporosis were 0.84 (95% CI, 0.78 to 0.90), 0.56 (95% CI, 0.52 to 0.60) and 0.23 (95% CI, 0.21 to 0.25) when cumulative defined daily doses (cDDDs) ranged from 28 to 90, 91 to 365, and more than 365, respectively, relative to nonusers. Otherwise, high-potency statins (rosuvastatin and atorvastatin) and moderate-potency statin (simvastatin) seemed to have a potential protective effect for osteoporosis. Conclusions In this population-based cohort study, we found that statin use is associated with a decreased risk of osteoporosis in both genders. The osteoprotective effect of statins seemed to be more prominent with a dependency on the cumulative dosage and statin intensity.
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Morse LR, Coker J, Battaglino RA. STATINS AND BONE HEALTH: A MINI REVIEW. ACTUALIZACIONES EN OSTEOLOGIA 2018; 14:31-35. [PMID: 30237809 PMCID: PMC6143288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Statins are a widely prescribed class of medications that inhibit similar pathways as the anti-resorptive bisphosphonate drugs. Statins target the mevalonate pathway by blocking HMG-CoA reductase. Several recent meta-analyses concluded statins are osteoprotective in the general population. Here we present current literature exploring the mechanisms underlying the putative osteoprotective effects of statins. We also review recent clinical studies, ranging from observational cohort studies to randomized clinical trials, testing the effect of statins on bone health in various populations.
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Affiliation(s)
- Leslie R. Morse
- Rocky Mountain Regional Spinal Injury System, Craig Rehabilitation Hospital, Englewood, Colorado, United States of America
- Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, Colorado, United States of America
| | - Jennifer Coker
- Rocky Mountain Regional Spinal Injury System, Craig Rehabilitation Hospital, Englewood, Colorado, United States of America
| | - Ricardo A. Battaglino
- Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, Colorado, United States of America
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