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

  • Original Article
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European Journal of Applied Physiology Aims and scope Submit manuscript

Abstract

Purpose

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.

Methods

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

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.

Conclusions

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.

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Abbreviations

ABT:

Activity based therapy

BMC:

Bone mineral content

BMD:

Bone mineral density

C:

Cervical

CTX:

Serum C-terminal telopeptide of type I collagen

DXA:

Dual-energy X-ray absorptiometry

FES:

Functional electrical stimulation

L:

Lumbar

PINP:

Procollagen type 1 N propeptide

SCI:

Spinal cord injury

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Acknowledgments

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

None.

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Authors and Affiliations

  1. Department of Kinesiology, California State University, San Marcos, 333. S. Twin Oaks Valley Road, UNIV 320, San Marcos, CA, 92096-0001, USA

    Todd Anthony Astorino & Kara A. Witzke

  2. Project Walk® Spinal Cord Injury Recovery Center, Carlsbad, CA, USA

    Eric T. Harness

  3. Department of Sport and Exercise Science, Oregon State University – Cascades, Bend, OR, USA

    Kara A. Witzke

Authors
  1. Todd Anthony Astorino
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  2. Eric T. Harness
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  3. Kara A. Witzke
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Corresponding author

Correspondence to Todd Anthony Astorino.

Additional information

Communicated by Fabio Fischetti.

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Astorino, T.A., Harness, E.T. & Witzke, K.A. Effect of chronic activity-based therapy on bone mineral density and bone turnover in persons with spinal cord injury. Eur J Appl Physiol 113, 3027–3037 (2013). https://doi.org/10.1007/s00421-013-2738-0

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  • DOI: https://doi.org/10.1007/s00421-013-2738-0

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