Rehabilitation: Neurogenic Bone Loss after Spinal Cord Injury

Biomedicines, 2023 · DOI: https://doi.org/10.3390/biomedicines11092581 · Published: September 20, 2023

Spinal Cord Injury Rehabilitation Musculoskeletal Medicine

Simple Explanation

Spinal cord injury (SCI) can lead to rapid and severe bone and muscle loss due to neurogenic factors, disuse, and cellular events, increasing fracture risk and reducing quality of life. Neurogenic bone loss after SCI is caused by immobility and de-loading, leading to increased bone resorption and decreased osteoblast activity. Current and future therapies for reducing or eliminating neurogenic bone loss after SCI focus on pharmacological and non-pharmacological approaches.

Study Duration

Not specified

Participants

Not specified

Evidence Level

Review

Key Findings

1
Immobility and de-loading after SCI increase bone resorption and decrease osteoblast activity, resulting in osteopenia.
2
Signaling pathways like 4-1BB, RANKL, and Wnt play critical roles in the cellular and molecular mechanisms of bone loss after SCI.
3
Therapeutic strategies such as bisphosphonates, Denosumab, exercise, and stem cell therapy are being evaluated to combat neurogenic bone loss after SCI.

Research Summary

Spinal cord injury (SCI) leads to neurogenic bone loss, predisposing individuals to osteoporosis and fractures, significantly limiting physical and functional capacity. Pharmacological treatments like ellagic acid, Adiponectin, Denosumab, and bisphosphonates, along with non-pharmacological therapies such as exercise, physiotherapy, and stem cell therapy, are being explored to improve bone density after SCI. Appropriate tailoring of therapeutic approaches to individual SCI patients, considering factors such as time after injury and patient-specific comorbidities, is essential for maximizing treatment effectiveness.

Practical Implications

Personalized Therapy

Tailor therapeutic approaches based on individual SCI patient characteristics, including time since injury and comorbidities.

Combination Therapies

Develop novel combination therapies that integrate pharmacological and non-pharmacological approaches to maximize bone density improvements.

Early Intervention

Implement early intervention strategies post-SCI to prevent or mitigate the onset of neurogenic bone loss and subsequent fractures.

Study Limitations

1
Pharmacological therapies are relatively ineffective in fully restoring bone density.
2
Non-pharmacological treatments have limitations in patients who are wheelchair-bound.
3
More research is needed to determine the exact mechanisms underlying the development and progression of complications over time after SCI.

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