Neglecting Bone Health: A Critical Gap in Management of Muscle Spasticity with Botulinum Toxin in Spinal Cord Injury

Journal of Musculoskeletal and Neuronal Interactions, 2024 · DOI: · Published: July 18, 2024

Spinal Cord Injury Pharmacology Musculoskeletal Medicine

Simple Explanation

Botulinum toxin (BTX) is used to treat muscle spasticity by weakening muscles, but this can lead to bone loss because muscles are essential for bone remodeling. Spinal cord injury (SCI) provides a model to explore how BTX affects bone, looking at the impact of spasticity, the positive and negative effects of BTX, and the role of the nervous system. This paper reviews how muscle paralysis from BTX can disturb the balance between muscles and bones, leading to bone loss.

Study Duration

Not specified

Participants

Not specified

Evidence Level

Narrative Review

Key Findings

1
BTX might exert a direct influence on bone resorption.
2
Multiple applications of BTX in muscle might lead to atrophy and fibrosis.
3
The disruption of the normal muscle-bone equilibrium, brought about by the impaired release or transport of specific biochemical factors due to repeated acute muscle paralysis from BTX, leads to osteopenia and bone resorption

Research Summary

This paper presents a narrative review of research findings on the disturbance of the typical balance between muscles and bones caused by acute muscle paralysis from BTX, resulting in osteopenia and bone resorption. The review highlights that bone loss following spinal cord injury (SCI) is influenced by multiple factors, including reduced mechanical stress, neurological abnormalities, and hormonal alterations. The paper concludes that while BTX is used to treat spasticity after SCI, it can negatively affect bone mineral density due to cellular and molecular alterations, potentially worsening osteoporosis associated with SCI.

Practical Implications

Monitoring Bone Health

Clinicians should closely monitor individuals receiving repeated BTX injections for alterations in skeletal structures.

Dosage Considerations

Clinicians should contemplate administering lesser doses of BTX whenever feasible to minimize potential bone loss.

AFO Utilization

Proper ankle-foot orthoses (AFOs) should be used for walking to support compromised bone health and reduce the risk of falls and fractures in individuals receiving BTX injections.

Study Limitations

1
Scarcity of studies restricted analysis to human bone outcomes and secondary examination of animal datasets.
2
Methodological rigor of the clinical trials included was not assessed using the Jadad scale.
3
The relationship between bone loss and the dosage and frequency of administration of BTX is currently unknown.

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