Kannisto M, Alaranta H, Merikanto J, Kröger H, Kärkkäinen J
Children's Hospital, University of Helsinki, Finland.
Spinal Cord. 1998 Sep;36(9):641-6. doi: 10.1038/sj.sc.3100665.
The impact of spinal cord injury (SCI) on later bone mineral status was studied in 35 adults who had sustained their injury in childhood. The median age of the patients was 31 years, the median age at injury 12.9 years and the median time period from injury was 19 years. The methods used in the study were clinical interview and examination, measurement of bone mineral density (BMD) of the lumbar spine and the proximal femur with dual energy X-ray absorptiometry (DEXA) and estimation of bone turnover with biochemical markers. The densitometric examination revealed that the BMD at the lumbar spine was within the normal range but grossly decreased in the femoral region. Moreover, there was a significant difference in BMD between patients with high (C2-T6) and low (below T6) lesions in the lumbar spine as well as in the femoral region. Patients with lower lesions had higher BMD values. The markers of bone turnover which were studied were serum and urinary calcium and phosphate serum alkaline phosphatase and its isoenzymes, osteocalcin, carboxyterminal propeptide of human type I procollagen (PICP), carboxyterminal telopeptide of type I collagen (ICTP) and urinary deoxypyridinoline. These markers of bone metabolism showed no signs of ongoing accelerated bone formation or resorption. The present study suggests that caution should be observed in weight bearing training or mobilisation of patients with pediatric SCI or perhaps with long standing SCI because of increased fracture risk. The prevention of dissociated osteoporosis should be investigated further in order to avoid fractures of weakened bones. The modes of prevention might be found in the use of modern pharmacotherapy of osteoporosis and from correctly dosage physical training.
对35名童年期脊髓损伤（SCI）的成年人进行了研究，以探讨脊髓损伤对后期骨矿物质状态的影响。患者的中位年龄为31岁，受伤时的中位年龄为12.9岁，受伤后的中位时间为19年。该研究采用的方法包括临床访谈和检查、用双能X线吸收法（DEXA）测量腰椎和股骨近端的骨密度（BMD）以及用生化标志物评估骨转换。骨密度检查显示，腰椎的骨密度在正常范围内，但股骨区域明显降低。此外，腰椎和股骨区域高损伤（C2-T6）和低损伤（T6以下）患者的骨密度存在显著差异。损伤较低的患者骨密度值较高。所研究的骨转换标志物包括血清和尿钙、磷、血清碱性磷酸酶及其同工酶、骨钙素、人I型前胶原羧基末端前肽（PICP）、I型胶原羧基末端端肽（ICTP）和尿脱氧吡啶啉。这些骨代谢标志物没有显示出正在进行的加速骨形成或吸收的迹象。本研究表明，由于骨折风险增加，对于儿童期脊髓损伤或长期脊髓损伤的患者，在负重训练或活动时应谨慎。应进一步研究预防分离性骨质疏松症，以避免脆弱骨骼发生骨折。预防方法可能在于使用现代骨质疏松症药物治疗以及正确剂量的体育锻炼。
