Bone Loss and Muscle Atrophy in Spinal Cord Injury: Epidemiology, Fracture Prediction, and Rehabilitation Strategies

J Spinal Cord Med, 2006 · DOI: · Published: January 1, 2006

Spinal Cord Injury Musculoskeletal Medicine

Simple Explanation

Individuals with spinal cord injury (SCI) often experience bone loss and muscle atrophy. Muscle atrophy can result in reduced metabolic rate and increase the risk of metabolic disorders. Sublesional osteoporosis predisposes individuals with SCI to an increased risk of low-trauma fracture. Fractures in people with SCI have been reported during transfers from bed to chair, and while being turned in bed. A number of interventions, including standing, electrically stimulated cycling or resistance training, and walking exercises have been explored with the aim of reducing bone loss and/or increasing bone mass and muscle mass in individuals with SCI.

Study Duration

Not specified

Participants

Individuals with spinal cord injury

Evidence Level

Review Article

Key Findings

1
Muscle atrophy can result in reduced metabolic rate and increase the risk of metabolic disorders.
2
Sublesional osteoporosis predisposes individuals with SCI to an increased risk of low-trauma fracture.
3
Exercise with electrical stimulation appears to increase muscle mass and/or prevent atrophy, but studies investigating its effect on bone are conflicting.

Research Summary

Individuals with SCI not only lose motor and/or sensory function, they experience dramatic muscle and bone changes. Functional electrical stimulation is a method of exercise that has been employed in the SCI population that has demonstrated some success in improving muscle, with less conclusive evidence that it has a positive effect on bone. Future research should carefully consider the study design, the measurement sites, and the measurement techniques used in order to facilitate sound conclusions.

Practical Implications

Exercise interventions

Standing, electrically stimulated cycling, resistance training, and walking exercises may reduce bone loss and increase bone and muscle mass in individuals with SCI.

Risk assessment

For individuals with SCI who participate in exercise or activities involving mechanical loading of the lower limbs, an assessment of risk should be performed by a qualified physician before initiation of the proposed activities.

Early mobilization

Early weight-bearing after acute SCI by standing or treadmill walking may reduce bone loss.

Study Limitations

1
Several methodological limitations in exercise studies with individuals with SCI to date limit our ability to confirm the utility of exercise for improving skeletal status.
2
The impact of standing or walking exercises on muscle and bone has not been well established.
3
Limitations in study design restrict the conclusions that can be made regarding the effect of exercise on the skeleton and should be acknowledged.

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