Department of Kinesiology and Nutrition, University of Illinois at Chicago, 1919 W. Taylor Street, 650 AHSB, M/C 517, Chicago, IL 60612, USA.
Osteoporos Int. 2013 Sep;24(9):2461-9. doi: 10.1007/s00198-013-2323-8. Epub 2013 Mar 7.
This study used quantitative computed tomography to assess changes in bone mineral at the proximal femur after acute spinal cord injury (SCI). Individuals with acute SCI experienced a marked loss of bone mineral from a combination of trabecular and endocortical resorption. Targeted therapeutic interventions are thus warranted in this population.
SCI is associated with a rapid loss of bone mineral and an increased rate of fragility fracture. Some 10 to 20% of these fractures occur at the proximal femur. The purpose of this study was to quantify changes to bone mineral, geometry, and measures of strength at the proximal femur in acute SCI.
Quantitative computed tomography analysis was performed on 13 subjects with acute SCI at serial time points separated by a mean of 3.5 months (range, 2.6-4.8 months). Changes in bone mineral content (BMC) and volumetric bone mineral density (vBMD) were quantified for integral, trabecular, and cortical bone at the femoral neck, trochanteric, and total proximal femur regions. Changes in bone volumes, cross-sectional areas, and surrogate measures of compressive and bending strength were also determined.
During the acute period of SCI, subjects experienced a 2.7-3.3%/month reduction in integral BMC (p < 0.001) and a 2.5-3.1 %/month reduction in integral vBMD (p < 0.001). Trabecular BMC decreased by 3.1-4.7 %/month (p < 0.001) and trabecular vBMD by 2.8-4.4 %/month (p < 0.001). A 3.9-4.0 %/month reduction was observed for cortical BMC (p < 0.001), while the reduction in cortical vBMD was noticeably lower (0.8-1.0 %/month; p ≤ 0.01). Changes in bone volume and cross-sectional area suggested that cortical bone loss occurred primarily through endosteal resorption. Declines in bone mineral were associated with a 4.9-5.9 %/month reduction in surrogate measures of strength.
These data highlight the need for therapeutic interventions in this population that target both trabecular and endocortical bone mineral preservation.
本研究使用定量计算机断层扫描来评估急性脊髓损伤（SCI）后股骨近端的骨矿物质变化。急性 SCI 患者的骨矿物质大量流失，这是由骨小梁和内皮质吸收共同作用的结果。因此，该人群需要有针对性的治疗干预措施。
SCI 会导致骨矿物质迅速流失，脆性骨折的发生率增加。其中约 10%至 20%的骨折发生在股骨近端。本研究的目的是定量评估急性 SCI 患者股骨近端骨矿物质、几何形状和强度指标的变化。
对 13 例急性 SCI 患者进行了多次定量计算机断层扫描分析，两次分析的时间间隔平均为 3.5 个月（范围为 2.6-4.8 个月）。对股骨颈、转子间和整个股骨近端区域的整体、小梁和皮质骨的骨矿物质含量（BMC）和体积骨矿物质密度（vBMD）变化进行了量化。还确定了骨体积、横截面积以及抗压和弯曲强度的替代测量值的变化。
在 SCI 的急性期间，患者的整体 BMC 每月减少 2.7-3.3%（p<0.001），整体 vBMD 每月减少 2.5-3.1%（p<0.001）。小梁 BMC 每月减少 3.1-4.7%（p<0.001），小梁 vBMD 每月减少 2.8-4.4%（p<0.001）。皮质 BMC 每月减少 3.9-4.0%（p<0.001），而皮质 vBMD 的减少明显较低（0.8-1.0%/月；p≤0.01）。骨体积和横截面积的变化表明，皮质骨丢失主要通过内皮质吸收发生。骨矿物质的减少与强度替代测量值每月减少 4.9-5.9%有关。
这些数据强调了该人群需要进行治疗干预，以靶向保留小梁和内皮质骨矿物质。
