Differences in Bone Mineral Density, Markers of Bone Turnover and Extracellular Matrix and Daily Life Muscular Activity Among Patients with Recent Motor-Incomplete Versus Motor-Complete Spinal Cord Injury
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Spinal cord injury (SCI) leads to severe bone loss, but the associated mechanisms are poorly described in incomplete SCI individuals. The purpose of the study is to compare alterations in bone mineral density (BMD) and serum biomarkers of bone turnover in recent motor-incomplete to -complete SCI men, as well as to describe their physical activity and spasticity. We studied 31 men with acute SCI. Whole-body DXA scans, serum biomarkers and self-reported activity and spasticity were examined 1 and/or 3 and 12 months after the injury. We observed a decrease in proximal femur BMD (p < 0.02) in both the groups. Serum phosphate and carboxy-terminal-collagen crosslinks were significantly lower in motor-incomplete versus complete SCI men, whereas albumin-corrected Ca2+ (p = 0.02) were lower only 3 months after injury. When data from all 31 SCI participants were pooled, we observed increased serum matrix metalloproteinase-2 (MMP-2) and tissue inhibitors of MMP-2 (TIMP-2) (p < 0.02) whereas TIMP-1 decreased (p = 0.03). BMD correlated positively with self-reported activity (r = 0.59, p = 0.04) and negatively with spasticity (r = 0.74, p = 0.02) 12 months after injury. As a summary, men with motor-incomplete SCI developed significant proximal femur bone loss 12 months after injury and exhibited increased bone resorption throughout the first year after the injury. Compared with complete SCI men, incomplete SCI men show attenuated bone resorption. Our pooled data show increased turnover of extracellular matrix after injury and that increased exercise before and after injury correlated with reduced bone loss.
KeywordsBone metabolism Extracellular matrix Physical activity Spasticity and spinal cord injury
We wish to thank the staff at Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital Oslo, Norway for all the help with the DXA-measurements and analysis, and Anne Lannem, the Department of Science, Sunnaas Rehabilitation Hospital, Nesoddtangen, Norway for the help with the physical activity questionnaires. A special thanks to Ingeborg Lidal, for allowing us to quote her unpublished data; Jan Falck and Kåre Birkeland, the Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital Oslo, Norway for expert advice; and Hilde Einerkjær, Mariann Madsen Voll and Sunnaas Rehabilitation Hospital, Nesoddtangen, for performing the blood sampling.
Conflicts of Interest
No conflicts of interest, financial or otherwise, are declared by the authors Emil Kostovski, Nils Hjeltnes, Erik Fink Eriksen, Svein Olav Kolset, and Per Ole Iversen.
Human and Animal Rights and Informed Consent
Each study participant gave verbal and written informed consent prior to the study.
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