Osteoporosis International

, Volume 4, Issue 3, pp 138–143 | Cite as

Bone mineral status in paraplegic patients who do or do not perform standing

  • S. Goemaere
  • M. Van Laere
  • P. De Neve
  • J. M. Kaufman
Original Article


Bone mineral density (BMD) was assessed by dual-photon X-ray absorptiometry at the lumbar spine (L3, L4), the proximal femur and the femoral shaft, and by single-photon absorptiometry at the forearm in 53 patients with complete traumatic paraplegia of at least 1 year's duration and in age- and sex-matched healthy controls. The patients did (n=38) or did not (n=15) regularly perform passive weightbearing standing with the aid of a standing device. Compared with the controls, the BMD of paraplegic patients was preserved in the lumbar spine and was markedly decreased in the proximal femur (33%) and the femoral shaft (25%). When considering all patients performing standing, they had a better-preserved BMD at the femoral shaft (p=0.009), but not at the proximal femur, than patients not performing standing. BMD at the lumbar spine (L3,L4) was marginally higher in the standing group (significant only for L3;p=0.040). A subgroup of patients performing standing with use of long leg braces had a significantly higher BMD at the proximal femur than patients using a standing frame or a standing wheelchair (p=0.030). The present results suggest that passive mechanical loading can have a beneficial effect on the preservation of bone mass in osteoporosis found in paraplegics.


Bone mineral density Paraplegia Spinal cord injury Standing 


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  1. 1.
    Chantraine A. L'ostéoporose et les para-ostéo-arthropathies au cours de la paraplégie. Brussels: Editions Arscia, 1979.Google Scholar
  2. 2.
    Chantraine A. Actual concepts of osteoporosis in paraplegia. Paraplegia 1978;16:51–8.Google Scholar
  3. 3.
    Klein L, Van De Noort S, Dejak JJ. Sequential studies of urinary hydroxyproline and serum alkaline phosphatase in acute paraplegia. Med Serv J Can 1966;22:524–33.Google Scholar
  4. 4.
    Chantraine A, Nusgens B, Lapiere CM. Bone remodeling during the development of osteoporosis in paraplegics. Calcif Tiss Int 1986;38:323–7.Google Scholar
  5. 5.
    Privat C, Martinazzo J, Ohanna F. Physiopathologie: ‘os, peau, contractures’. In: Actes des Seconds Entretiens de la Fondation Garches, 6–7 October 1989:27–45.Google Scholar
  6. 6.
    Chantraine A. Clinical investigation of bone metabolism in spinal cord lesions. Paraplegia 1971;8:253–9.Google Scholar
  7. 7.
    Minaire P, Meunier PJ, Edouard C, et al. Quantitative histological data on disuse osteoporosis. Calcif Tissue Res 1974;17:57–73.Google Scholar
  8. 8.
    Bergmann P, Heilporn A, Schoutens A, et al. Longitudinal study of calcium and bone metabolism in paraplegic patients. Paraplegia 1977;15:147–59.Google Scholar
  9. 9.
    Minaire P, Berard E, Meunier PJ, et al. Effects of disodium dichloromethylene diphosphonate on bone loss in paraplegic patients. J Clin Invest 1981;68:1086–92.Google Scholar
  10. 10.
    Naftchi NE, Viau AT, Sell GH, et al. Mineral metabolism in spinal cord injury. Arch Phys Med Rehabil 1980;61:139–42.Google Scholar
  11. 11.
    Kaplan PE, Roden W, Gilbert E, et al. Reduction of hypercalciuria in tetraplegia after weight-bearing and strengthening exercises. Paraplegia 1981;19:289–93.Google Scholar
  12. 12.
    Abramson AS. Bone disturbances in injuries to the spinal cord and cauda equina (paraplegia). J Bone Joint Surg [Am] 1948;30:982–7.Google Scholar
  13. 13.
    Biering-Sörensen F, Bohr H, Schaadt O. Bone mineral content of the lumbar spine and lower extremities years after spinal cord lesion. Paraplegia 1988;26:293–301.Google Scholar
  14. 14.
    Ashworth B. Preliminary trial of carisoprodol in multiple sclerosis. Practitioner 1964;192:540–2.Google Scholar
  15. 15.
    Keith R, Granger C, Hamilton B, Sherwin F. The functional independence measure: a new tool for rehabilitation. Adv Clin Rehabil 1987;1:6–18.Google Scholar
  16. 16.
    Brooker A, Bowerman J, Robinson R, et al. Ectopic ossification following total hip replacement. J Bone Joint Surg [Am] 1973;55:1629–39.Google Scholar
  17. 17.
    Glantz SA, Slinker BK. Primer of applied regression and analysis of variance. New York: MacGraw-Hill, 1990.Google Scholar
  18. 18.
    Frost HM. Perspectives: bone's mechanical usage windows. Bone Miner 1992;19:257–71.Google Scholar
  19. 19.
    Kaplan E, Gandhavadi B, Richars L, et al. Calcium balance in paraplegic patients: influence of injury duration and ambulation. Arch Phys Med Rehabil 1978;59:447–50.Google Scholar
  20. 20.
    Martin P, Verhas M, Als C, Geerts L, Paternot J, Bergmann P. Influence of patient's weight on dual-photon absorptiometry and dual-energy X-ray absorptiometry measurements of bone mineral density. Osteoporosis Int 1993;3:198–203.Google Scholar
  21. 21.
    Whalen RT, Arnaud SB, Grindeland RE. Proceedings of the NASA symposium on the influence of gravity and activity on muscle and bone. J Biomech 1991;24:1–178.Google Scholar
  22. 22.
    Gutin B, Kasper MJ. Can vigorous exercise play a role in osteoporosis prevention? A review. Osteoporosis Int 1992;2:55–69.Google Scholar
  23. 23.
    LeBlanc AD, Schneider VS, Evans HJ, Engelbretson DA, Krebs JM. Bone mineral loss and recovery after 17 weeks of bed rest. J Bone Miner Res 1990;5:843–50.Google Scholar
  24. 24.
    Arnaud SB, Morey-Holton E. Gravity, calcium, and bone: update 1989. Physiologist 1990;33:S65–68.Google Scholar
  25. 25.
    Schneider V, Oganov A, LeBlanc A, Rakhmanov A, Bakulin A, Grigoriev A, Varonin L. Space flight bone loss and change in fat and lean body mass. J Bone Miner Res 1992;7:S122.Google Scholar
  26. 26.
    Ragnarsson KT, Seel GH. Lower extremity fractures after spinal cord injury: a restrospective study. Arch Phys Med Rehabil 1981;62:418–23.Google Scholar
  27. 27.
    Oden I, Knutsson E. Evaluation of the effects of muscle stretch and weight load in patients with spastic paraplegia. Scand J Rehabil Med 1981;13:117–21.Google Scholar

Copyright information

© European Foundation for Osteoporosis 1994

Authors and Affiliations

  • S. Goemaere
    • 1
  • M. Van Laere
    • 2
  • P. De Neve
    • 2
  • J. M. Kaufman
    • 1
  1. 1.Osteoporosis and Bone Metabolism Unit of the Departments of Rheumatology and EndocrinologyUniversity Hospital of GhentGhentBelgium
  2. 2.Rehabilitation CentreUniversity Hospital of GhentGhentBelgium

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