Neurogenic Obesity and Skeletal Pathology in Spinal Cord Injury

Top Spinal Cord Inj Rehabil, 2021 · DOI: 10.46292/sci20-00035 · Published: January 1, 2021

Spinal Cord Injury Endocrinology Musculoskeletal Medicine

Simple Explanation

Spinal cord injury (SCI) leads to significant changes in body composition, including decreased lean mass and increased fat mass, which can negatively impact cardiometabolic health. Obesity in SCI is often determined using body composition models that account for regional fat distribution, which differs from the general population. Bone loss is a common complication of SCI, particularly in the lower extremities. Specific DXA protocols are recommended to accurately assess bone health in individuals with SCI, focusing on areas most affected by bone loss. Obesity and bone loss in SCI may interact through metabolic, autonomic, and endocrine pathways, potentially affecting bone health. Inflammation, altered adipokine levels, and changes in bone marrow composition may play a role in this interaction.

Study Duration

Not specified

Participants

Not specified

Evidence Level

Review

Key Findings

1
SCI leads to regionally specific changes in body composition, with increased adiposity around the viscera, skeletal muscle, and bone marrow.
2
Bone loss after SCI disproportionately affects lower extremity long bones, with significant decreases in bone mineral density (BMD) occurring early post-injury.
3
The ISCD recommends that all adults with new SCI have BMD assessed via DXA at the total hip, proximal tibia, and distal femur.

Research Summary

Spinal cord injury (SCI) results in dramatic changes in body composition, with lean mass decreasing and fat mass increasing in specific regions that have important cardiometabolic implications. The recent Consortium for Spinal Cord Medicine (CSCM) released clinical practice guidelines for cardiometabolic disease (CMD) in SCI recommending the use of compartmental modeling of body composition to determine obesity in adults with SCI. Recent CSCM clinical practice guidelines for CMD and the ISCD official position on DXA should be used by clinicians for the early detection and continued monitoring of obesity and bone health in persons with SCI.

Practical Implications

Improved diagnostic accuracy

Using compartmental models of body composition and SCI-specific DXA protocols can improve the accuracy of diagnosing obesity and skeletal pathology in SCI.

Early intervention

Early detection of bone loss and obesity can enable timely interventions to mitigate cardiometabolic risks and prevent fractures.

Personalized treatment strategies

Understanding the interaction between adipose and skeletal pathologies in SCI can guide the development of personalized treatment strategies targeting both conditions.

Study Limitations

1
Lack of large-scale interventional studies examining fracture risk in SCI.
2
Limited data on the plateau in knee region BMD following the 2019 ISCD guidelines.
3
Incomplete understanding of the biomechanical and biochemical mechanisms by which excess bone marrow fat relates to poor bone health.

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