Review of osteokines in spinal cord injury: potential biomarkers during rehabilitation

Journal of Orthopaedic Surgery and Research, 2025 · DOI: https://doi.org/10.1186/s13018-024-05415-2 · Published: December 25, 2024

Spinal Cord Injury Rehabilitation Musculoskeletal Medicine

Simple Explanation

Spinal cord injury (SCI) can lead to bone density loss and an increased risk of osteoporosis. This is due to factors like mechanical unloading and inflammation. Bones secrete proteins called osteokines, which affect bone density, muscle mass, and even brain function. Therefore, monitoring bone density and osteokine levels is crucial during SCI rehabilitation. Rehabilitation treatments like exercise and acupuncture can influence osteokine levels. These treatments could serve as biomarkers, reflecting bone density and overall health during SCI rehabilitation. Understanding the role of osteokines may offer new avenues for SCI treatment, addressing not only bone loss but also systemic complications. This review discusses bone loss, osteokine changes, and the impact of rehabilitation on bone health after SCI. It emphasizes osteokines' local and systemic effects, suggesting their potential as biomarkers during rehabilitation to track bone density and systemic functions.

Study Duration

Not specified

Participants

Not specified

Evidence Level

Review

Key Findings

1
Osteoporosis is common after SCI, especially in the distal femur and proximal tibia, increasing fracture risk.
2
SCI can significantly alter osteokine levels, such as RANKL, sclerostin, and osteocalcin, which are crucial for bone and muscle health.
3
Osteokines play regulatory roles in bone, muscle, the central nervous system, and metabolism, making them potential biomarkers for SCI rehabilitation and targets for treatment.

Research Summary

This review summarizes recent findings regarding bone loss after SCI, changes in osteokines, and the effect of rehabilitation therapies, with a particular emphasis on the local and systemic regulatory roles of osteokines, as well as their potential as biomarkers during SCI rehabilitation. The etiology of bone loss after SCI is likely multifactorial from direct and indirect reasons (Fig. 1). The direct factors are unloading and denervation after SCI, while the indirect reasons leading to bone loss mainly include reduced blood supply, an increased inflammatory state, and changes in hormone levels among subjects with SCI. Clinical treatments of SCI or its complications mainly rely on pharmaceutical agents, and rehabilitation is represented by exercise training, physical agent therapy, and acupuncture [7, 8, 62–65]. Potential therapeutic measures for osteoporosis mainly include pharmaceutical agents, nutritional support, and exercise training.

Practical Implications

Bone Density Evaluation

Recommend evaluation of bone density, especially in the spine and around the knee, during SCI rehabilitation.

Osteokine Examination

Stress the examination of osteokines after SCI to comprehensively evaluate body function and health state.

Targeted Clinical Measures

Emphasize clinical measures targeting increased RANKL or sclerostin, and decreased osteocalcin after SCI to regulate osteokine levels.

Study Limitations

1
Heterotopic ossification after SCI, related to osteokine levels, needs further study.
2
The association between serum osteokine levels and functional outcomes requires testing.
3
The underlying molecular mechanisms of osteokine regulation on bone density and systemic function after SCI should be studied further.

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