European Journal of Applied Physiology

, Volume 113, Issue 12, pp 3027–3037 | Cite as

Effect of chronic activity-based therapy on bone mineral density and bone turnover in persons with spinal cord injury

  • Todd Anthony AstorinoEmail author
  • Eric T. Harness
  • Kara A. Witzke
Original Article



Osteoporosis is a severe complication of spinal cord injury (SCI). Many exercise modalities are used to slow bone loss, yet their efficacy is equivocal. This study examined the effect of activity-based therapy (ABT) targeting the lower extremities on bone health in individuals with SCI.


Thirteen men and women with SCI (age and injury duration = 29.7 ± 7.8 and 1.9 ± 2.7 years) underwent 6 months of ABT. At baseline and after 3 and 6 months of training, blood samples were obtained to assess bone formation (serum procollagen type 1 N propeptide (PINP) and bone resorption (serum C-terminal telopeptide of type I collagen (CTX), and participants underwent dual-energy X-ray absorptiometry scans to obtain total body and regional estimates of bone mineral density (BMD).


Results demonstrated significant increases (p < 0.05) in spine BMD (+4.8 %; 1.27 ± 0.22–1.33 ± 0.24 g/cm2) and decreases (p < 0.01) in total hip BMD (−6.1 %; 0.98 ± 0.18–0.91 ± 0.16 g/cm2) from 0 to 6 months of training. BMD at the bilateral distal femur (−7.5 to −11.0 %) and proximal tibia (− 8.0 to −11.2 %) declined but was not different (p > 0.05) versus baseline. Neither PINP nor CTX was altered (p > 0.05) with training.


Chronic activity-based therapy did not reverse bone loss typically observed soon after injury, yet reductions in BMD were less than the expected magnitude of decline in lower extremity BMD in persons with recent SCI.


Osteoporosis Paralysis Exercise training Bone turnover Bone mineral density Spinal cord injury 



Activity based therapy


Bone mineral content


Bone mineral density




Serum C-terminal telopeptide of type I collagen


Dual-energy X-ray absorptiometry


Functional electrical stimulation




Procollagen type 1 N propeptide


Spinal cord injury



This project was funded by a grant from the National Institutes of Health SC3GM095416-02. The authors also thank the subjects for their dedication to this project as well as Brian J. Martin, M.S., L.V.N., John Lyon R.N., and Katya Geronimo L.V.N. for performing the blood draws.

Conflict of interest



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Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Todd Anthony Astorino
    • 1
    Email author
  • Eric T. Harness
    • 2
  • Kara A. Witzke
    • 1
    • 3
  1. 1.Department of KinesiologyCalifornia State UniversitySan MarcosUSA
  2. 2.Project Walk® Spinal Cord Injury Recovery CenterCarlsbadUSA
  3. 3.Department of Sport and Exercise ScienceOregon State University – CascadesBendUSA

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