Skip to main content
SpringerLink
Log in

Immobilization osteoporosis: a review

  • Published:
Clinical Rheumatology Aims and scope Submit manuscript

Summary

Bone mass is not only subject to systemic hormonal homeostatic mechanisms, but also to local mechanical influences. The importance of the mechanical balance of bone has been more recently stressed by the research on the effect of weightlessness on bone, and by the introduction of the concept of “mechanostat” in the pathogenesis of osteoporotic conditions. Immobilization osteoporosis has clinical (fractures, sometimes hypercalcemia, urinary lithiasis) and radiological features. Immobilization has an effect on bone modeling and remodeling, through an increased activation of remodeling loci, and a decrease of the osteoblastic stimulus. This leads directly to a local reduction in bone mass, the increased activation multiplying the effect of the deficit in bone formation. The prevention is based on exercise if the load is applied intermittently for a daily period. It seems also that muscle weight is an important determinant of bone mass. There is a potential for recovery during the active early phase of immobilization osteoporosis that may disappear in the subsequent late (about six months) inactive phase. Permanent losses could be prevented by appropriate measures, pharmacology or exercises, applied during the first months of immobilization. No recovery has been demonstrated after the inactive phase has been reached, whatever the treatment. The cumulative effect of repeated periods of immobilization remains hypothetical.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Albright, F., Burnett, C.H., Cope, O., Parson, W. Acute atrophy of bone (osteoporosis) simulating hyperparathyroidism. J Clin Endocrinol 1941, 1, 711–716.

    Google Scholar 

  2. Whedon, G.D. Disuse osteoporosis. In: Bone as a Tissue. Editor: Rodahl, K., Nicholson, J.T., Brown, E.M., New York, McGraw Hill, 1960, 67–99.

    Google Scholar 

  3. Whedon, G.D., Schorr, E. Metabolic studies in paralytic acute anterior poliomyelitis. II: Alterations in calcium and phosphorus metabolism. J Clin Invest 1957, 36, 966–981.

    Google Scholar 

  4. Deitrick, J.E., Whedon, G.D., Schorr, E. Effects of immobilization upon various metabolic and physiologic functions in normal men. Am J Med 1948, 4, 3–36.

    Google Scholar 

  5. Minaire, P., Meunier, P., Edouard, C., Bernard, J., Courpron, P., Bourret, J., Quantitative histological data on disuse osteoporosis: comparison with biological data. Calcif Tissue Res 1974, 17, 57–73.

    Google Scholar 

  6. Bergmann, P., Heilporn, A., Schoutens, A., Paternot, J., Tricot, A. Longitudinal study of calcium and bone metabolism in paraplegic patients. Paraplegia, 1977, 15, 147–159.

    Google Scholar 

  7. Naftchi, N.E., Viau, A.T., Sell, G.H., Lowman, E.W. Mineral metabolism in spinal cord injury. Arch Phys Med Rehabil 1980, 61, 139–142.

    Google Scholar 

  8. Rose, G.A. Immobilization osteoporosis: study of extent, severity, and treatment with bendrofluazide. Br J Surg 1966, 53, 769–774.

    Google Scholar 

  9. Hansson, T.H., Roos, B.O., Nachemson, A. Development of osteopenia in fourth lumbar vertebra during prolonged bed rest after operation for scoliosis. Acta Orthop Scand 1975, 46, 621–630.

    Google Scholar 

  10. Krolner, B., Toft, B. Vertebral bone loss: an unheeded side effect of therapeutic bed rest. Clin Sci 1983, 64, 537–540.

    Google Scholar 

  11. Donaldson, C.L., Hulley, S.B., Vogel, J.M., Hattner, R.S., Bayers, J.H., McMillan, D.E. Effect of prolonged bed rest on bone mineral. Metabolism, 1970, 19, 1071–1084.

    Google Scholar 

  12. Schneider, V.S., McDonald, J. Skeletal calcium homeostasis and countermeasures to prevent disuse osteoporosis. Calcif Tissue Int 1984, 36 (suppl. 1), S151-S154.

    Google Scholar 

  13. Currey, J.D. The mechanical adaptations of bones. Princeton University Press. 1984, 294 p.

  14. Frost, H.M. The mechanostat: a proposed pathogenic mechanism of osteoporosis and the bone mass effect of mechanical and non-mechanical agents. Bone Mineral, 1987, 2, 73–85.

    Google Scholar 

  15. Nishiyama, S., Kuwahara, T., Matsuda, I. Decreased bone density in severely handicapped children and adults, with reference to the influence of limited mobility and anticonvulsant medication. Eur J Pediatr 1986, 144, 457–463.

    Google Scholar 

  16. Comarr, A.E., Hutchinson, R.H., Bors, E. Extremity fractures of patients with spinal cord injuries. Am J Surg 1962, 103, 732–739.

    Google Scholar 

  17. Eichenholtz, S.N. Management of long bone fractures in paraplegic patients. J Bone Joint Surg 1963, 45-A, 299–310.

    Google Scholar 

  18. Ragnarsson, K.T., Sell, G.H. Lower extremity fractures after spinal cord injury: retrospective study. Arch Phys Med Rehabil 1981, 62, 418–423.

    Google Scholar 

  19. Howard, J.E., Parson, W., Bingham, R.S. Studies on patients convalescent from fracture. J Hopkins Hosp Bull 1945, 77, 291–313.

    Google Scholar 

  20. Hulth, A., Johnell, O., Willner, S. The effect of scoliosis surgery on parathormone, calcitonin, and calcium levels in serum and the urinary excretion of calcium. Intern Orthop (SICOT) 1981, 5, 139–141.

    Google Scholar 

  21. Minaire, P., 'Meunier, P., Berard, E., Girard, R., Bourret, J. L'Hypercalcémie d'immobilisation. Nouv Presse Méd 1977, 6, 3843–3846.

    Google Scholar 

  22. Hyman, L.R., Boner, G., Thomas, J.C., Segar, W.E. Immobilization hypercalcemia. Am J Dis Child 1972, 124, 723–727.

    Google Scholar 

  23. Fuss, M., Bergans, A., Corvilain, J. Hypercalcemia due to immobilisation in Paget's disease of bone. Lancet, 1978, 28, 10.

    Google Scholar 

  24. Heath, H., Earll, J.M., Schaaf, M., Piechoki, J.T., Li, T.K. Serum ionised calcium during bed rest in fracture patients and normal men. Metabolism, 1972, 21, 633–640.

    Google Scholar 

  25. Leadbetter, W.F., Engster, H.C. The problem of renal lithiasis in convalescent patients. J Urol 1945, 53, 269–281.

    Google Scholar 

  26. Tori, J.A., Kewalramani, L.S. Urolithiasis in children with spinal cord injury. Paraplegia, 1978, 16, 357–365.

    Google Scholar 

  27. Jones, G. Radiological appearances of disuse osteoporosis. Clin Radiol 1969, 20, 345–353.

    Google Scholar 

  28. Joyce, J.M., Keats, T.E. Disuse osteoporosis: Mimic of neoplastic disease. Skeletal Radiol 1986, 15, 129–132.

    Google Scholar 

  29. Yagan, R., Radivoyevitch, M., Khan, M.A. Double cortical line in the acetabular roof: a sign of disuse osteoporosis. Radiology 1987, 165, 171–175.

    Google Scholar 

  30. Lockwood, D.R., Vogel, J.M., Schneider, V.S., Hulley, S.B. Effect of the diphosphonate EHDP on bone mineral metabolism during prolonged bed rest. J Clin Endocrinol Metab 1975, 41, 533–541.

    Google Scholar 

  31. Hulley, S.B., Vogel, J.M., Donaldson, C.L., Bayers, J.H., Friedman, R.J., Rosen, S.N. The effect of supplemental oral phosphate on the bone mineral changes during prolonged bed rest. J Clin Invest 1971, 50, 2506–2518.

    Google Scholar 

  32. Stewart, A.F., Adler, M., Byers, C.M., Segre, G.V., Broadus, A.E. Calcium homeostasis in immobilization: an example of resorptive hypercalciuria. N Engl J Med 1982, 306, 1136–1140.

    Google Scholar 

  33. Rambaut, P.C., Goode, A.W. Skeletal changes during space flight. Lancet, 1985, ii, 1050–1052.

    Google Scholar 

  34. Minaire, P., Berard, E., Edouard, C., Goedert, G., Pilonchery, G. Effects of disodium dichloromethylene diphosphonate on bone loss in paraplegic patients. J Clin Invest 1981, 68, 1086–1092.

    Google Scholar 

  35. Heaney, R.P. Radiocalcium metabolism in disuse osteoporosis in man. Am J Med 1962, 33, 188–200.

    Google Scholar 

  36. Leach, C.S., Rambaut, P.C., Di Ferranti, N. Amino aciduria in weightlessness. Acta Astronautica, 1979, 6, 1323–1333.

    Google Scholar 

  37. Pilonchery, G., Minaire, P., Milan, J.J., Revol, A. Urinary elimination of glycosaminoglycans during immobilization osteoporosis of spinal cord injury patients. Clin Orthop 1983, 174, 230–235.

    Google Scholar 

  38. Young, D.R., Yeh, I., Swenson, R.S. Metabolic alkalosis during immobilization in monkeys (M. nemestrina). Calcif Tissue Int 1983, 35, 472–476.

    Google Scholar 

  39. Hulth, A., Johnell, O. Parathyroid hormone secretion after operative bone trauma. Acta Orthop Scand 1979, 50, 241–243.

    Google Scholar 

  40. Sandler, H., Webb, P., Annis, J., Pace, N., Grunbaum, B.W., Dolkas, D., Newsom, B. Evaluation of a reverse gradient garment for prevention of bedrest deconditioning. Aviat Space Environ Med 1983, 54, 191–201.

    Google Scholar 

  41. LaRochelle, F., Leach, C., Vernikos-Daniellis, J. Effects of age and sex on hormonal responses to weightlessness simulation. Physiologist, 1982, 25 (suppl.) S161-S162.

    Google Scholar 

  42. Dolkas, C., Greenleaf, J. Insulin and glucose responses during prolonged bed rest with isotonic and isometric exercise. J Appl Physiol 1977, 43, 1033–1038.

    Google Scholar 

  43. Vico, L., Chappard, D., Alexandre, C., Palle, S., Minaire, P., Morukov, B.V., Rakhmanov, A.S., Oganov, V.S. Etude histologique quantitative de la masse et des activités cellulaires osseuses après un décubitus de 120 jours. Essai de protocoles préventifs. Ann Biol Clin 1987, 45, 145–151.

    Google Scholar 

  44. Klein, L., Player, J.S., Heiple, K.G., Bahniuk, E., Goldberg, V.M. Isotopic evidence for resorption of soft tissues and bone in immobilized dogs. J Bone Joint Surg 1982, 64-A, 225–230.

    Google Scholar 

  45. Uhthoff, H.K., Jaworski, Z.F.G. Bone loss in response to long term immobilisation. J Bone Joint Surg 1978, 60-B, 420–429.

    Google Scholar 

  46. Young, D.R., Niklowitz, W.J., Brown, J.R., Jee, W.S.S. Immobilization-associated osteoporosis in primates. Bone, 1986, 7, 109–117.

    Google Scholar 

  47. Minaire, P., Edouard, C., Meunier, P. Les modifications de l'os trabéculaire induites par l'hypodynamie. Space Physiologie/Physiologie spatiale Editor: C.N.E.S., CEPADUES, Toulouse, 1983, 215–221.

    Google Scholar 

  48. Wronski, T.J., Morey, E.R. Inhibition of cortical and trabecular bone formation in the long bones of immobilized monkeys. Clin Orthop 1983, 181, 269–276.

    Google Scholar 

  49. National Aeronautics and Space Administration, The Life Sciences Division: Research opportunities in bone demineralization. Contract Number NASW 3728, 1983, 71 p.

  50. Rodan, G., Thompson, D.D., Weinreb, M. Characterization and pharmacological control of immobilization-induced bone résorption. In: Osteoporosis 1987. Editors: C. Christiansen, B. Riis. Osteopress, Copenhagen, 1987, 762–766.

    Google Scholar 

  51. Tschopp, A., Cogoli, A. Hypergravity promotes cell proliferation. Experientia, 1983, 39, 1323–1329.

    Google Scholar 

  52. Burger, E.H., Klein-Nulend, J., Van Strien, M.E., Veldhuijzen, J.P. Inhibiting effect of mechanical stimulation on bone resorption in vitro. In: Osteoporosis 1987. Editors: C. Christiansen, B. Riis, Osteopress, Copenhagen, 1987, 767–770.

    Google Scholar 

  53. Vignon, G., Meunier, P., Pansu, D., Bernard, J., Chapuy, P., Edouard, C., Courpron, P. Enquête clinique et anatomique sur l'étiopathogénie de l'ostéoporose sénile. Rev Rhum 1970, 37, 615–627.

    Google Scholar 

  54. Mosekilde, Li., Mosekilde, Le., Danielsen, C.C. Biomechanical competence of vertebral trabecular bone in relation to ash density and age in normal individuals. Bone, 1987, 8, 79–85.

    Google Scholar 

  55. Mattson, S. The reversibility of disuse osteoporosis. Experimental studies in the adult rat. Acta Orthop Scand 1972, suppl. 144.

  56. Jaworski, Z.F.G., Uhthoff, H.K. Reversibility of nontraumatic disuse osteoporosis during its active phase. Bone, 1986, 7, 431–439.

    Google Scholar 

  57. Sinaki, M., McPhee, M.C., Hodgson, S.F., Merritt, J.M., Offord, K.P. Relationship between bone mineral density of spine and strength of back extensors in healthy post-menopausal women. Mayo Clin Proc 1986, 61, 116–122.

    Google Scholar 

  58. Doyle, F., Brown, J., Lachance, C. Relation between bone mass and muscle weight. Lancet, 1970, 1, 391–393.

    Google Scholar 

  59. Martin, A.D., Bailey, D.A., Leicester, J.B., Gulka, I. Bone and muscle relationships in the forearms of lifetime tennis players In: Osteoporosis 1987. Editors: C. Christiansen, B. Riis. Osteopress, Copenhagen, 1987, 599–600.

    Google Scholar 

  60. Rubin, C.T., Lanyon, L.E. Regulation of bone formation by applied dynamic loads. J Bone Joint Surg 1984, 66-A, 397–402.

    Google Scholar 

  61. Lutz, J., Fouchen, Kasper, C.E. Hypokinesia-induced negative net calcium balance reversed by weight-bearing exercise. Aviat Space Environ Med 1987, 58, 308–314.

    Google Scholar 

  62. Issekutz, B., Blizzard, J.J., Birkhead, N.C., Rodahl, K. Effect of prolonged bed rest on urinary calcium output. J Appl Physiol 1966, 21, 1013–1020.

    Google Scholar 

  63. Dalen, N., Olsson, K.E. Bone mineral content and physical activity. Acta Orthop Scand 1974, 45, 170–174.

    Google Scholar 

  64. Margulies, J.Y., Simkin, A., Leichter, I., Bivas, A., Steinberg, R., Giladi, M., Stein, M., Kashtan, H., Milgrom, C. Effect of intense physical activity on the bone mineral content in the lower limbs of young adults. J Bone Joint Surg 1986, 68-A, 1090–1093.

    Google Scholar 

  65. Smith, E.L., Reddan, W., Smith, P.E. Physical activity and calcium modalities for bone mineral increase in aged women. Med Sci Sports Exerc 1981, 13, 60–64.

    Google Scholar 

  66. Sinaki, M., Offord, K.P. Physical activity in post-menopausal women: effect on back muscle strength and bone mineral density of the spine. Arch Phys Med Rehabil 1988, 69, 277–280.

    Google Scholar 

  67. Lane, N.E., Bloch, D.A., Jones, H.H., Marshall, W.H., Wood, P.D., Fries, J.F. Long-distance running, bone density and osteoarthritis. JAMA, 1986, 255, 1147–1151.

    Google Scholar 

  68. Ringe, J.D., Steinhagen-Thiessen, E. Prevention of physiological age-dependent bone atrophy by controlled exercise in mice. Age, 1985, 2, 44–47.

    Google Scholar 

  69. Rigotti, N.A., Nussbaum, S.R., Herzog, D.B., Neer, R.M. Osteoporosis in women with anorexia nervosa. N Engl J Med 1984, 311, 1601–1606.

    Google Scholar 

  70. Smith, E.L., Gilligan, C. Effects of inactivity and exercise on bone. The Physician and Sports Medicine, 1987, 15, 91–100.

    Google Scholar 

  71. Tipton, C.M. Considerations for exercise prescriptions in future space flights. Med Sci Sports Exerc 1983, 15, 441–444.

    Google Scholar 

  72. Burr, D.B., Frederickson, R.G., Pavlinch, C., Sickles, M., Burkart, S. Intracast muscle stimulation prevents bone and cartilage deterioration in cast-immobilized rabbits. Clin Orthop 1984, 189, 264–278.

    Google Scholar 

  73. Minaire, P., Meunier, P., Edouard, C., Messy, P., Depassio, J., Caulin, F., Pilonchery, G., Berard, E. In: Osteoporosis. Acute osteoporosis in paraplegic patients: pathophysiology and effects of treatment with calcitonin and dichloromethylene diphosphonate. Editors: Menczel, J., Robin, G.C., Makin, M., Steinberg, R. J. Wiley and sons, Chichester, 1982, 421–428.

    Google Scholar 

  74. Minaire, P., Mallet, E., Levernieux, J., Schoutens, A., Caulin, F. Immobilization bone loss: preventing effect of calcitonin in several clinical models. In: Osteoporosis 1987. Editors: C. Christiansen, B. Riis. Osteopress, Copenhagen, 1987, 603.

    Google Scholar 

  75. Minaire, P., Depassio, J., Berard, E., Meunier, P.J., Edouard, C., Pilonchery, G., Goedert, G. Effects of clodronate on immobilization bone loss. Bone, 1987, 8, suppl. 1, S63-S68.

    Google Scholar 

  76. Schneider, V.S., McDonald, J. Prevention of disuse osteoporosis: clodronate therapy. In: Osteoporosis, recent advances in pathogenesis and treatment. Editors: DeLuca, H.F., Frost, H.M., Jee, W.S.S., Johnston, C.C., Parfitt, A.M. Baltimore, University Park Press, 1981, 491.

    Google Scholar 

  77. Yates, A.J.P., Jones, T.H., Mundy, K.I., Hague, R.V., Brown, C.B., Guilland-Cumming, D., Kanis, J.A. Immobilisation hypercalcaemia in adults and treatment with clodronate. Br Med J 1984, 289, 1111–1112.

    Google Scholar 

  78. Bone, H.G. III, Zerwekh, J.E., Britton, F., Pak, C.Y.C. Treatment of calcium urolithiasis with diphosphonate: efficacy and hazards. J Urol 1979, 121, 568–571.

    Google Scholar 

  79. Alexandre, C., Chappard, D., Vico, L., Minaire, P., Riffat, G. Effects de l'apesanteur sur le métabolisme phospho-calcique et le remodelage osseux. Presse Med 1986, 15, 923–927.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Departments of Rehabilitation Medicine, C.H.R.U. Hôpital Bellevue, F)42023, Saint-Etienne 2, France

    P. Minaire

  2. G.I.P. Exercice, The University of Saint-Etienne Medical School, F-42023, Saint-Etienne 2, France

    P. Minaire

Authors
  1. P. Minaire
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Minaire, P. Immobilization osteoporosis: a review. Clin Rheumatol 8 (Suppl 2), 95–103 (1989). https://doi.org/10.1007/BF02207242

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02207242

Key words

Search

Navigation