Archives of Physical Medicine and Rehabilitation
Volume 90, Issue 7 , Pages 1127-1135 , July 2009

A Study of Bone Mineral Density in Adults With Disability

Presented to the American Academy of Physical Medicine and Rehabilitation, September 27, 2007, Boston, MA.

  • Éimear M. Smith, MRCPI

      Affiliations

    • Department of Rehabilitation Medicine, National Rehabilitation Hospital, Dublin, Ireland
    • Corresponding Author InformationReprint requests to Éimear M. Smith, MRCPI, Dept of Rehabilitation Medicine, National Rehabilitation Hospital, Dún Laoghaire, Dublin, Ireland
    • ,
  • Catherine M. Comiskey, PhD

      Affiliations

    • School of Nursing and Midwifery, Trinity College, Dublin, Ireland
    • ,
  • Áine M. Carroll, MRCP

      Affiliations

    • Department of Rehabilitation Medicine, National Rehabilitation Hospital, Dublin, Ireland

References 

  1. Kanis JA. Diagnosis of osteoporosis and assessment of fracture risk. Lancet. 2002;359:1929–1936
  2. Poole KE, Compston JE. Osteoporosis and its management. Br Med J. 2006;333:1251–1256
  3. Giangregorio L, Blimkie CJ. Skeletal adaptations to alterations in weight-bearing activity: a comparison of models of disuse osteoporosis. Sports Med. 2002;32:459–476
  4. Jiang SD, Dai LY, Jiang LS. Osteoporosis after spinal cord injury. Osteoporos Int. 2006;17:180–192
  5. Jiang SD, Jiang LS, Dai LY. Mechanisms of osteoporosis in spinal cord injury. Clin Endocrinol. 2006;65:555–565
  6. Levendoglu F, Ugurlu H, Gurbilek M, Akkurt E, Karagozoglu E. Increased bone resorption in the proximal femur in patients with hemiplegia. Am J Phys Med Rehabil. 2004;83:835–841
  7. Poole KE, Loveridge N, Barker PJ, et al. Reduced vitamin D in acute stroke. Stroke. 2006;37:243–245
  8. Sato Y, Fujimatsu Y, Kikuyama M, Kaji M, Oizumic K. Influence of immobilization on bone mass and bone metabolism in hemiplegic elderly patients with a long-standing stroke. J Neurol Sci. 1998;156:205–210
  9. Sato Y, Fujimatsu Y, Honda Y, Kunoh H, Kikuyama M, Oizumi K. Accelerated bone remodeling in patients with post-stroke hemiplegia. J Stroke Cardiovasc Dis. 1998;7:58–62
  10. Sato Y, Kuno H, Kaji M, Ohshima Y, Asoh T, Oizumi K. Increased bone resorption during the first year after stroke. Stroke. 1998;29:1373–1377
  11. Sato Y, Oizumi K, Kuno H, Kaji M. Effect of immobilization upon renal synthesis of 1,25-dihydroxyvitamin D in disabled elderly stroke patients. Bone. 1999;24:271–275
  12. Sato Y, Maruoka H, Oizumi K, Kikuyama M. Vitamin D deficiency and osteopenia in the hemiplegic limbs of stroke patients. Stroke. 1996;27:2183–2187
  13. Pack AM. The association between anti-epileptic drugs and bone disease. Epilepsy Curr. 2003;3:91–95
  14. Agha A, Thompson CJ. High risk of hypogonadism after traumatic brain injury. Pituitary. 2005;8:245–249
  15. Sze K, Wong E, Leung HY, Woo J. Falls among Chinese stroke patients during rehabilitation. Arch Phys Med Rehabil. 2001;82:1219–1225
  16. Suzuki T, Sonoda S, Misawa K, Saitoh E, Shimizu Y, Kotake T. Incidence and consequence of falls in in-patient rehabilitation of stroke patients. Exp Aging Res. 2005;31:457–469
  17. Forster A, Young J. Incidence and consequences of falls due to stroke: a systematic inquiry. Br Med J. 1995;311:83–86
  18. Jorgensen L, Engstad T, Jacobsen BK. Higher incidence of falls in long-term stroke survivors than in population controls. Stroke. 2002;33:542–547
  19. Stoker Yates J, Min Lai S, Duncan PW, Studenski S. Falls in community-dwelling stroke survivors: an accumulated impairments model. J Rehabil Res Dev. 2002;39:385–394
  20. Stolze H, Klebe S, Zechlin C, Baecker C, Friege L, Deuschl G. Falls in frequent neurological diseases. J Neurol. 2004;251:79–84
  21. Aisen ML, Iverson D, Schwalbe C, Weaver B, Aisen PS. Falls on a neurorehabilitation unit: reassessment of a prevention programme. J Am Paraplegia Soc. 1994;17:179–182
  22. Miller WC, Speechley M, Deathe B. The prevalence and risk factors of falling and fear of falling among lower extremity amputees. Arch Phys Med Rehabil. 2001;82:1031–1037
  23. Vlahov D, Myers AH, Al-Ibrahim MS. Epidemiology of falls among patients in a rehabilitation hospital. Arch Phys Med Rehabil. 1990;71:8–12
  24. Gooday HM, Hunter J. Preventing falls and stump injuries in lower limb amputees during inpatient rehabilitation: completion of the audit cycle. Clin Rehabil. 2004;18:379–390
  25. Teasell R, McRae M, Foley N, Bhardwaj A. The incidence and consequences of falls in stroke patients during in-patient rehabilitation: factors associated with high risk. Arch Phys Med Rehabil. 2002;83:329–333
  26. Perennou D, El Fatami A, Masmoudi M, et al. Incidence, circumstances and consequences of falls in patients undergoing rehabilitation after a first stroke. Ann Readapt Med Phys. 2005;48:138–145
  27. Watanabe Y. Fear of falling among stroke survivors after discharge from in-patient rehabilitation. Int J Rehabil Res. 2005;28:149–152
  28. Poplingher AR, Pillar T. Hip fracture in stroke patients. Acta Orthop Scand. 1985;56:226–227
  29. Chiu KY, Pun WK, Luk KD, Chow SP. A prospective study on hip fractures in patients with previous cerebrovascular accidents. Injury. 1992;23:297–299
  30. Ramnemark A, Nilsson M, Borssen B, Gustafson Y. Stroke, a major and increasing risk factor for femoral neck fracture. Stroke. 2000;31:1572–1577
  31. Ragnarsson KT, Sell GH. Lower extremity fractures after spinal cord injury: a retrospective study. Arch Phys Med Rehabil. 1981;62:418–423
  32. Ingram RR, Suman RK, Freeman PA. Lower limb fractures in the chronic spinal cord injured patient. Paraplegia. 1989;27:133–139
  33. Keating JF, Kerr M, Delargy M. Minimal trauma causing fractures in patients with spinal cord injury. Disabil Rehabil. 1992;14:108–109
  34. Gonzalez EG, Matthews MM. Femoral fractures in patients with lower extremity amputations. Arch Phys Med Rehabil. 1980;61:276–280
  35. Denton JR, McClelland SJ. Stump fractures in lower extremity amputees. J Trauma. 1985;25:1074–1078
  36. Bowker JH, Rills BM, Ledbetter CA, Hunter GA, Holliday P. Fractures in lower limbs with prior amputation. J Bone Joint Surg Am. 1981;63:915–920
  37. Kanis JA, Gluer C-C. An update on the diagnosis and assessment of osteoporosis with densitometry (Committee of Scientific Advisors, International Osteoporosis Foundation). Osteoporos Int. 2000;11:192–202
  38. Marshall D, Johnell O, Wedel H. Meta-analysis of how well measures of bone mineral density predict occurrence of osteoporotic fractures. Br Med J. 1996;312:1254–1259
  39. Kanis JA, Johnell O, Oden A, Dawson A, De Laet C, Jonsson B. Ten year probabilities of osteoporotic fractures according to BMD and diagnostic thresholds. Osteoporos Int. 2001;12:989–995
  40. Kanis JA, Johnell O, Oden A, De Laet C, Mellstrom D. Diagnosis of osteoporosis and fracture threshold in men. Calcif Tissue Int. 2001;69:218–221
  41. Fitzsimmons A, Bonner F, Lindsay R. Failure to diagnose osteoporosis, a commentary. Arch Phys Med Rehabil. 1995;74:240–242
  42. Shinchuk LM, Morse L, Huancahuari N, Arum S, Chen TC, Holick MF. Vitamin D deficiency and osteoporosis in rehabilitation in-patients. Arch Phys Med Rehabil. 2006;87:904–908
  43. Smeltzer SC, Zimmerman V, Capriotti T. Osteoporosis risk and low bone mineral density in women with physical disabilities. Arch Phys Med Rehabil. 2005;86:582–586
  44. Holick MF. Vitamin D deficiency. N Engl J Med. 2007;357:266–281
  45. Binkley N, Kendler D, Leib E, Lewiecki M, Petak S. Official positions of the International Society for Clinical Densitometry. Vancouver, BC, Canada: Position Development Conference; 2005;
  46. Baim S, Wilson CR, Lewiecki EM, Luckey MM, Downs RW, Lentle BC. Precision assessment and radiation safety for dual-energy x-ray absorptiometry (DXA). J Clin Densitom. 2005;8:371–378
  47. Sato Y, Asoh T, Kondo I, Satoh K. Vitamin D deficiency and risk of hip fractures among disabled elderly stroke patients. Stroke. 2001;32:1673–1677
  48. Dovio A, Perazzolo L, Osella G, et al. Immediate fall of bone formation and transient increase of bone resorption in the course of high-dose short-term glucocorticoid therapy in young patients with multiple sclerosis. J Clin Endocrinol Metab. 2004;89:4923–4928
  49. Nieves J, Cosman F, Herbert J, Shen V, Lindsay R. High prevalence of vitamin D deficiency and reduced bone mass in multiple sclerosis. Neurology. 1994;44:1687–1692
  50. Ozgocmen S, Bulut S, Ilhan N, Gulkesen A, Ardioglu O, Ozkan Y. Vitamin D deficiency and reduced bone mineral density in multiple sclerosis: effect of ambulatory status and functional capacity. J Bone Miner Metab. 2005;23:309–313
  51. Francis RM, Selby PL. Osteomalacia. Balliere's Clinical Endocrinology and Metabolism. 1997;11:145–163
  52. Sato Y, Kaji M, Honda Y, et al. Abnormal calcium homeostasis in disabled stroke patients with low 25-hydroxyvitamin D. Bone. 2004;34:710–715
  53. Sato Y, Kuno H, Asoh T, Honda Y, Oizumi K. Effect of immobilization on vitamin D status and bone mass in chronically hospitalized disabled stroke patients. Age Ageing. 1999;28:265–269
  54. Weinstock-Guttman B, Gallagher E, Baier M, et al. Risk of bone loss in men with osteoporosis. Mult Scler. 2004;10:170–175
  55. Iwamoto J, Tsukimura T, Takeda T. Bone mineral density of metatarsus in hemiplegic subjects. Am J Phys Med Rehabil. 1999;78:202–207
  56. Takamoto S, Masuyama T, Nakajima M, et al. Alterations of bone mineral density of the femurs in hemiplegia. Calcif Tissue Int. 1995;56:259–262
  57. Jorgensen L, Jacobsen BK, Wilsgaard T, Magnus JH. Walking after stroke: does it matter? (Changes in bone mineral density within the first 12 months after stroke: a longitudinal study). Osteoporos Int. 2000;11:381–387
  58. Jorgensen L, Crabtree NJ, Reeve J, Jacobsen BK. Ambulatory level and asymmetrical weight bearing after stroke affects bone loss in the upper and lower part of the femoral neck differently: bone adaptation after decreased mechanical loading. Bone. 2000;27:701–707
  59. Jorgensen L, Jacobsen BK. Changes in muscle mass, fat mass and bone mineral content in the legs after stroke: a 1 year prospective study. Bone. 2001;28:655–659
  60. Worthen LC, Kim CM, Kautz SA, Lew HL, Kiratli BJ, Beaupre GS. Key characteristics of walking correlate with bone density in individuals with chronic stroke. J Rehabil Res Dev. 2005;42:761–768
  61. Gilchrist NL, Frampton CM, Acland RH, et al. Alendronate prevents bone loss in patients with acute spinal cord injury: a randomized, double-blind placebo-controlled study. J Clin Endocrinol Metab. 2007;92:1385–1390
  62. Nance PW, Schryvers O, Leslie W, Ludwig S, Krahn J, Uebelhart D. Intravenous pamidronate attenuates bone density loss after acute spinal cord injury. Arch Phys Med Rehabil. 1999;80:243–251
  63. Shapiro J, Smith B, Beck T, et al. Treatment with zoledronic acid ameliorates negative geometric changes in the proximal femur following acute spinal cord injury. Calcif Tissue Int. 2007;80:316–322
  64. Zehnder Y, Risi S, Michel D, et al. Prevention of bone loss in paraplegics over 2 years with alendronate. J Bone Miner Res. 2004;19:1067–1074
  65. Pearson EG, Nance PW, Leslie WD, Ludwig S. Cyclical etidronate: its effects on bone density in patients with acute spinal cord injury. Arch Phys Med Rehabil. 1997;78:269–272
  66. Sniger W, Garshick E. Alendronate increases bone density in chronic spinal cord injury: a case report. Arch Phys Med Rehabil. 2002;83:139–140
  67. del Puente A, Pappone N, Mandes MG, Mantova D, Scrpa R, Oriente P. Determinants of bone mineral density in immobilization: a study on hemiplegic patients. Osteoporos Int. 1996;6:50–54
  68. Demirbag D, Ozdemir F, Kokino S, Berkarda S. The relationship between bone mineral density and immobilization duration in hemiplegic limbs. Ann Nucl Med. 2005;19:695–700
  69. Hamdy RC, Krishnaswamy G, Cancellaro V, Whalen K, Harvill L. Changes in bone mineral content and density. Am J Phys Med Rehabil. 1993;72:188–191
  70. Leslie WD, Nance PW. Dissociated hip and spine demineralization: a specific finding in spinal cord injury. Arch Phys Med Rehabil. 1993;74:960–964
  71. Lazo MG, Shirazi P, Sam M, Giobbie-Hurder A, Blacconiere MJ, Muppidi M. Osteoporosis and risk of fracture in men with spinal cord injury. Spinal Cord. 2001;39:208–214
  72. Bauman WA, Spungen AM, Wang J, Pierson RN, Schwartz E. Continuous loss of bone during chronic immobilization: a monozygotic twin study. Osteoporos Int. 1999;10:123–127
  73. Dauty M, Perrouin Verbe B, Maugars Y, Dubois C, Mathe JF. Supralesional and sublesional bone mineral density in spinal cord-injured patients. Bone. 2000;27:305–309
  74. Clasey JL, Janowiak AL, Gater DR. Relationship between regional bone density measurements and the time since injury in adults with spinal cord injuries. Arch Phys Med Rehabil. 2004;85:59–64
  75. Sabo D, Blaich S, Wenz W, Hohmann M, Loew M, Gerner HJ. Osteoporosis in patients with paralysis after spinal cord injury. Arch Orthop Trauma Surg. 2001;121:75–78
  76. Garland DE, Adkins RH, Stewart CA, Ashford R, Vigil D. Regional osteoporosis in women who have a complete spinal cord injury. J Bone Joint Surg Am. 2001;83-A:1195–1200
  77. Finsen V, Indredavik B, Fougner KJ. Bone mineral and hormone status in paraplegics. Paraplegia. 1992;30:343–347
  78. Bauman WA, Spungen AM, Morrison N, Zhang R-L, Schwartz E. Effect of a vitamin D analog on leg bone mineral density in patients with chronic spinal cord injury. J Rehabil Res Dev. 2005;42:625–634
  79. Demirel G, Yilmaz H, Paker N, Onel S. Osteoporosis after spinal cord injury. Spinal Cord. 1998;36:822–825
  80. Kaya K, Aybay C, Ozel S, Kutay N, Gokkaya O. Evaluation of bone mineral density in patients with spinal cord injury. J Spinal Cord Med. 2006;29:396–401
  81. Wood DE, Dunkerley AL, Tromans AM. Results from bone mineral density scans in twenty-two complete lesion paraplegics. Spinal Cord. 2001;39:145–148
  82. Vlychou M, Papadaki PJ, Zavras GM, et al. Paraplegia-related alterations of bone density in forearm and hip in Greek patients after spinal cord injury. Disabil Rehabil. 2003;25:324–330
  83. Kannisto M, Alaranta H, Merikanto J, Kroger H, Karkkainen J. Bone mineral status after pediatric spinal cord injury. Spinal Cord. 1998;36:641–646
  84. Shojaei H, Soroush MR, Modirian E. Spinal cord injury-induced osteoporosis in veterans. J Spinal Disord Tech. 2006;19:114–117
  85. Changlai SP, Kao CH. Bone mineral density in patients with spinal cord injuries. Nucl Med Commun. 1996;17:385–388
  86. Goemaere S, Van Laere M, De Neve P, Kaufman JM. Bone mineral status in paraplegic patients who do or do not perform standing. Osteoporos Int. 1994;4:138–143
  87. Frey-Rindova P, de Bruin ED, Stussi E, Dambacher MA, Dietz V. Bone mineral density in upper and lower extremities during 12 months after spinal cord injury measured by peripheral quantitative computed tomography. Spinal Cord. 2000;38:26–32
  88. Zehnder Y, Luthi M, Michel D, et al. Long-term changes in bone metabolism, bone mineral density, quantitative ultrasound parameters, and fracture incidence after spinal cord injury: a cross-sectional observational study in 100 paraplegic men. Osteoporos Int. 2004;15:180–189
  89. BeDell KK, Scremin AM, Perell KL, Kunkel CF. Effects of functional electrical stimulation-induced lower extremity cycling on bone density of spinal cord-injured patients. Am J Phys Med Rehabil. 1996;75:29–34
  90. Mohr T, Podenphant J, Biering-Sorensen F, Galbo H, Thambsborg G, Kjaer M. Increased bone mineral density after prolonged electrically induced cycle training of paralysed limbs in spinal cord injured man. Calcif Tissue Int. 1997;61:22–25
  91. Ogilvie C, Browker P, Rowley DI. The physiological benefits of paraplegic orthotically aided walking. Paraplegia. 1993;31:111–115
  92. Needham-Shropshire BM, Broton JG, Klose KJ, Lebwohl N, Guest RS, Jacobs PL. Evaluation of a training programme for persons with SCI paraplegia using the Parastep 1 ambulation system, part 3: lack of effect on bone mineral density. Arch Phys Med Rehabil. 1997;78:799–803
  93. Kunkel CF, Scremin E, Eisenberg B, Garcia JF, Roberts S, Mertinez S. Effect of “standing” on spasticity, contracture and osteoporosis in paralysed males. Arch Phys Med Rehabil. 1993;74:73–78
  94. Sato Y, Asoh T, Kaji M, Oizumi K. Beneficial effect of cyclical etidronate therapy in hemiplegic patients following an acute stroke. J Bone Miner Res. 2000;15:2487–2494
  95. Sato Y, Iwamoto J, Kanoko T, Satoh K. Risedronate therapy for prevention of hip fracture after stroke in elderly women. Neurology. 2005;64:811–816
  96. Sato Y, Iwamoto J, Kanoko T, Satoh K. Risedronate therapy for prevention of hip fracture in men 65 years or older after stroke. Arch Intern Med. 2005;165:1743–1748
  97. Poole KE, Loveridge N, Rose CM, Warburton EA, Reeve J. A single infusion of zoledronate prevents bone loss after stroke. Stroke. 2007;38:1519–1525

 Supported by the National Medical Rehabilitation Trust.

 No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.

PII: S0003-9993(09)00282-2

doi: 10.1016/j.apmr.2008.09.578

Archives of Physical Medicine and Rehabilitation
Volume 90, Issue 7 , Pages 1127-1135 , July 2009

Article Tools

* Image Usage & Resolution