Osteoporosis needs more attention if we want to walk again

[Norm]

Why is this not a major topic in the cure area? The lack of care by the sci community about this is mind numbing. :confused: Hey folks your not going to walk again if you don't solve this problem. Its as important as the cure itself.

[Eric.S]

doesn't weight bareing address this problem?

[Norm]

If your allowed to stand up.

[Isildur]

Not only bones. What happen with our muscles, tendons, joints?
Are there any promising research in those important fields?

[lynnifer]

I have noticed pharmaceutical commercials on tv lately with 'prevention' of osteo ... Boniva, Reclast with the later specifically geared towards hip and spine. The last info seminar I went to on aging with SCI informed us that older people are now becoming the biggest percentage of spinal cord injuries.

[Leif]

Why is this not a major topic in the cure area? The lack of care by the sci community about this is mind numbing. :confused: Hey folks your not going to walk again if you don't solve this problem. Its as important as the cure itself.http://www.businesswire.com/portal/site/google/?ndmViewId=news_view&newsId=20080506005458&newsLang=en

[Norm]

http://www.businesswire.com/portal/site/google/?ndmViewId=news_view&newsId=20080506005458&newsLang=en Geron strikes again. :applaud:

[FasterNow]

I just had a DEXA bone scan done to check my bone density in hope of getting a standing wheelchair. The chart that was in the room with the scanner had numbers ranging from -1 to -3 with -3 being high risk osteoporosis. I had my left wrist and left hip scanned with numbers of -3.4 and -3.7. I was very surprised with the results from the wrist. I'm only a little over a year and a half post and think of myself as fairly active. Kind of scary thinking about what my bones are going to be like a few years from now.

[stephen212]

I just had a DEXA bone scan done to check my bone density in hope of getting a standing wheelchair. The chart that was in the room with the scanner had numbers ranging from -1 to -3 with -3 being high risk osteoporosis. I had my left wrist and left hip scanned with numbers of -3.4 and -3.7. I was very surprised with the results from the wrist. I'm only a little over a year and a half post and think of myself as fairly active. Kind of scary thinking about what my bones are going to be like a few years from now.

FN,

It's important to distinguish b/t SCI-related osteoporosis and age-related osteoporosis. Don't know how old you are, but chances are your numbers aren't going to worsen any time soon. Most bone loss occurs within the first year post-injury and stabilizes after that. But if you live long enough, age will chip away at your bone density, as it does everyone. My doc, a physiatrist and internist, has me on Actonel to slow down age-related osteoporosis. (I've been taking it for about 2 years.)

There's no conclusive evidence that any of the osteoporosis treatment meds are effective for SCI-related bone density loss. Surprisingly, my last DEXA scan results showed a not-insignificant improvement, though I'm skeptical as to why -- technician/machine error, perhaps?

I've just begun an FES regimen at a local rehab facility and if I'm fortunate enough to buy one for home use and stick with it till December, the time of my next DEXA scan, I'll be very curious to see if there's any improvement.

[Isildur]

With this perspective, all advances in the regeneration field are useless for us chronics :frypan:
I hope to see some progress in this area or we will be in trouble.

[Norm]

Are there any home tilt tables? My Doc will let me tilt but not stand. Maybe the weight even at an angle will help.

[stephen212]

Are there any home tilt tables? My Doc will let me tilt but not stand. Maybe the weight even at an angle will help.
As has been discussed numerous times on CC, passive weight-bearing unless coupled with a modality that applies muscular stress on the bones (for example, doing FES cycle ergometry), has been reported to be useless as a tx for SCI-related osteoporosis. Of course, there's no conclusive evidence that even the combination of the two will reverse osteoporosis.

Download Bone Health Following Spinal Cord Injury (http://www.icord.org/scire/pdf/SCIRE_CH9.pdf)

[Norm]

As has been discussed numerous times on CC, passive weight-bearing unless coupled with a modality that applies muscular stress on the bones (for example, doing FES cycle ergometry), has been reported to be useless as a tx for SCI-related osteoporosis. Of course, there's no conclusive evidence that even the combination of the two will reverse osteoporosis.

Download Bone Health Following Spinal Cord Injury (http://www.icord.org/scire/pdf/SCIRE_CH9.pdf)

I did FES for over a year with very little improvement in the hips. infact one hip got worse. But maybe in combination.

[stephen212]

I did FES for over a year with very little improvement in the hips. infact one hip got worse. But maybe in combination.

You'll probably need to take osteoporosis treatment meds as well.

LATE RECOVERY AFTER MAJOR SPINAL CORD INJURY—IS IT POSSIBLE? THE CHRISTOPHER REEVE “N OF ONE” STUDY (http://www.neurologyreviews.com/nov02/nr_nov02_superman.html)
“Medication to prevent bone loss, physical activity, or FES alone can limit or stabilize—but not reverse—osteoporosis. The combination can,” Dr. McDonald noted. “In the hundreds of patients we have studied so far with patterned neural activity programs such as the FES bike, the improvement in physical factors such as osteoporosis, reduced risk of infection, maintaining skin integrity, and decreased spasticity is enormous, even in the absence of functional recovery,” he added. “There are huge dollar amounts associated with these changes, and our hope is that this case will help the insurance industry realize that there will be major cost savings from paying for ongoing activity-based therapy for spinal cord injury patients because these programs keep patients out of the hospital. Today, most spinal cord injury patients lose access to the equipment and staff required once they leave an inpatient rehabilitation program, and the duration of inpatient rehabilitation has gotten shorter and shorter over the past 10 years.”

[JenJen]

Looks like Geron is listening to you Norm. :) This just landed in my mailbox (thanks Karen!) I'm too sick to read it all right now but thought you'd be interested.

http://www.businesswire.com/portal/site/google/?ndmViewId=news_view&newsId=20080506005458&newsLang=en

[poonsuzanne]

Why is this not a major topic in the cure area? The lack of care by the sci community about this is mind numbing. :confused: Hey folks your not going to walk again if you don't solve this problem. Its as important as the cure itself.

Yes, I agree this should be a major cure topic. We are talking about not only osteoporosis but also severe muscular atrophy after SCI over the years!

I'm so worried!!! Seriously, if these issues are not addressed I am not sure whether I should believe in therapies which will help with ALL chronic SCIs to walk again. However, I have always been coping with my attitude to hope for the best and prepare for the worst.

[Isildur]

My worst nightmare would be to have therapies that can cure the spinal cord and be unable to walk because of this :sorry!:

[Norm]

My worst nightmare would be to have therapies that can cure the spinal cord and be unable to walk because of this :sorry!: Well I'm going through this right now. My Doc won't let me do locomotor training because my bone density is to low.

[wildwilly]

J Musculoskelet Neuronal Interact. 2008 Jan-Mar;8(1):50-7.

Age and motor score predict osteoprotegerin level in chronic spinal cord injury.

Morse LR, Nguyen HP, Jain N, Williams S, Tun CG, Battaglino RA, Stashenko P, Garshick E.

Department of Physical Medicine and Rehabilitation, Harvard Medical School and Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA.

Objective: Individuals with spinal cord injury (SCI) develop a severe form of osteoporosis below the level of injury that is poorly understood. We conducted a preliminary investigation to assess whether circulating markers of bone turnover and circulating RANKL/OPG levels are related to the severity of SCI, aging, or to differences in mobility (i.e., walking or using a wheelchair). Methods: Sixty-four caucasian men >/=1.6 years since injury selected based on locomotive mode provided blood samples and completed a health questionnaire at the VA Boston Healthcare System from 10/2003 to 6/2005. Plasma sRANKL, osteoprotegerin (OPG), osteocalcin and carboxyterminal telopeptide of type I collagen (CTx) levels were determined. Results: Increasing age was significantly associated with increased OPG and CTx. Injury severity was predictive of OPG levels, and adjusting for age, participants with cervical motor complete and ASIA C SCI (n=11) had significantly lower mean OPG (46.1 pg/ml) levels than others (63.4 pg/ml). Locomotive mode was not associated with differences in bone markers. Conclusions: Severe cervical spinal cord injury is associated with decreased circulating OPG levels placing these patients at risk for accelerated bone loss that appears unrelated to locomotive mode.

http://www.ismni.org/jmni/pdf/31/18MORSE.pdf

http://www.ncbi.nlm.nih.gov/pubmed/18398265?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_RVDocSum

[Isildur]

Seems that many of us(quads) have a darker future :mad:.
Its sad to know that important part of a cure like this is poorly attended.

[wildwilly]

Bone. 2008 Mar 20.

High-volume FES-cycling partially reverses bone loss in people with chronic spinal cord injury.

Frotzler A, Coupaud S, Perret C, Kakebeeke TH, Hunt KJ, Donaldson ND, Eser P.

Swiss Paraplegic Research, CH-6207 Nottwil, Switzerland.

Spinal cord injury (SCI) leads to severe bone loss in the paralysed limbs and to a resulting increased fracture risk thereof. Since long bone fractures can lead to comorbidities and a reduction in quality of life, it is important to improve bone strength in people with chronic SCI. In this prospective longitudinal cohort study, we investigated whether functional electrical stimulation (FES) induced high-volume cycle training can partially reverse the loss of bone substance in the legs after chronic complete SCI. Eleven participants with motor-sensory complete SCI (mean age 41.9+/-7.5 years; 11.0+/-7.1 years post injury) were recruited. After an initial phase of 14+/-7 weeks of FES muscle conditioning, participants performed on average 3.7+/-0.6 FES-cycling sessions per week, of 58+/-5 min each, over 12 months at each individual's highest power output. Bone and muscle parameters were investigated in the legs by means of peripheral quantitative computed tomography before the muscle conditioning (t(1)), and after six (t(2)) and 12 months (t(3)) of high-volume FES-cycle training. After 12 months of FES-cycling, trabecular and total bone mineral density (BMD) as well as total cross-sectional area in the distal femoral epiphysis increased significantly by 14.4+/-21.1%, 7.0+/-10.8% and 1.2+/-1.5%, respectively. Bone parameters in the femoral shaft showed small but significant decreases, with a reduction of 0.4+/-0.4% in cortical BMD, 1.8+/-3.0% in bone mineral content, and 1.5+/-2.1% in cortical thickness. These decreases mainly occurred between t(1) and t(2). No significant changes were found in any of the measured bone parameters in the tibia. Muscle CSA at the thigh increased significantly by 35.5+/-18.3%, while fat CSA at the shank decreased by 16.7+/-12.3%. Our results indicate that high-volume FES-cycle training leads to site-specific skeletal changes in the paralysed limbs, with an increase in bone parameters at the actively loaded distal femur but not the passively loaded tibia. Thus, we conclude that high-volume FES-induced cycle training has clinical relevance as it can partially reverse bone loss and thus may reduce fracture risk at this fracture prone site.

http://www.ncbi.nlm.nih.gov/pubmed/18440891?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_RVDocSum

[Wise Young]

Bone. 2008 Mar 20.

High-volume FES-cycling partially reverses bone loss in people with chronic spinal cord injury.

Frotzler A, Coupaud S, Perret C, Kakebeeke TH, Hunt KJ, Donaldson ND, Eser P.

Swiss Paraplegic Research, CH-6207 Nottwil, Switzerland.

Spinal cord injury (SCI) leads to severe bone loss in the paralysed limbs and to a resulting increased fracture risk thereof. Since long bone fractures can lead to comorbidities and a reduction in quality of life, it is important to improve bone strength in people with chronic SCI. In this prospective longitudinal cohort study, we investigated whether functional electrical stimulation (FES) induced high-volume cycle training can partially reverse the loss of bone substance in the legs after chronic complete SCI. Eleven participants with motor-sensory complete SCI (mean age 41.9+/-7.5 years; 11.0+/-7.1 years post injury) were recruited. After an initial phase of 14+/-7 weeks of FES muscle conditioning, participants performed on average 3.7+/-0.6 FES-cycling sessions per week, of 58+/-5 min each, over 12 months at each individual's highest power output. Bone and muscle parameters were investigated in the legs by means of peripheral quantitative computed tomography before the muscle conditioning (t(1)), and after six (t(2)) and 12 months (t(3)) of high-volume FES-cycle training. After 12 months of FES-cycling, trabecular and total bone mineral density (BMD) as well as total cross-sectional area in the distal femoral epiphysis increased significantly by 14.4+/-21.1%, 7.0+/-10.8% and 1.2+/-1.5%, respectively. Bone parameters in the femoral shaft showed small but significant decreases, with a reduction of 0.4+/-0.4% in cortical BMD, 1.8+/-3.0% in bone mineral content, and 1.5+/-2.1% in cortical thickness. These decreases mainly occurred between t(1) and t(2). No significant changes were found in any of the measured bone parameters in the tibia. Muscle CSA at the thigh increased significantly by 35.5+/-18.3%, while fat CSA at the shank decreased by 16.7+/-12.3%. Our results indicate that high-volume FES-cycle training leads to site-specific skeletal changes in the paralysed limbs, with an increase in bone parameters at the actively loaded distal femur but not the passively loaded tibia. Thus, we conclude that high-volume FES-induced cycle training has clinical relevance as it can partially reverse bone loss and thus may reduce fracture risk at this fracture prone site.

http://www.ncbi.nlm.nih.gov/pubmed/18440891?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_RVDocSum


Wildwilly, thanks. That is very interesting. Wise.

[Scott Buxton]

AND I understand that bisphosphonates basically significantly reduce the activity of osteoclasts, thus reduce the rate of bone demineralization for post-menopausal women (boniva, fosamax, AND reclast is a very long acting IV form). Might bisphosphonates work similarly with the osteoclasts of people with SCI? Thanks, Scott.

[stephen212]

AND I understand that bisphosphonates basically significantly reduce the activity of osteoclasts, thus reduce the rate of bone demineralization for post-menopausal women (boniva, fosamax, AND reclast is a very long acting IV form). Might bisphosphonates work similarly with the osteoclasts of people with SCI? Thanks, Scott.

There's no compelling evidence yet to support the efficacy of bisphosponates for treating SCI-induced osteoporosis. However, all SCIs, women particularly so, must also contend with age-induced osteoporosis and it's for the latter reason that my PCP (an internist and physiatrist) has me on Actonel.

[Scott Buxton]

Thank you.

Also, I don't want to argue with probably well designed studies' results, but why wouldN'T the bisphosphonates work? I guess I'm just curious about that.

Scott.

[Norm]

I'm having a hell of a time getting my numbers up with FES, Fosamax, Calcium & Vit D. I asked my Doc to let me use a tilt table a couple times a week since I'm not allowed to stand. Yet there's no protocol to follow. I have to wing it! :thinking:

[Scott Buxton]

BUT I guess at least your numbers areN'T going down. That's a very good thing. Scott.

[Norm]

BUT I guess at least your numbers areN'T going down. That's a very good thing. Scott. After a year, the weird thing is the fact that one hip's numbers went down the other hips numbers went up. :confused:

[Scott Buxton]

IF bisphosphonates areN'Teffective for people with SCI, but ARE effective for post-menopusal women, the question is WHY? Perhaps we could use bisphosphonates with people with SCI if we could medically have them mimic post-menopausal women. How to do that?Scott.

[wildwilly]

I think this article could help justify insurance coverage for standing frames in the future.

Spinal Cord. 2008 Apr 29.
Effect of weight-bearing activities on bone mineral density in spinal cord injured patients during the period of the first two years.

Alekna V, Tamulaitiene M, Sinevicius T, Juocevicius A.

Faculty of Medicine, Vilnius University, Vilnius, Lithuania [2] 2Institute of Clinical and Experimental Medicine at Vilnius University, Vilnius, Lithuania.

Study design:Prospective study on patients with spinal cord injuries.Objectives:To evaluate the loss of bone mineral density (BMD) in various body regions of patients with spinal cord injury (SCI) and its dependence on weight bearing activities during 2 years post injury.Methods:BMD of the whole body was measured in patients with SCI. Baseline measurement was performed in 6-16 weeks after SCI, the second and the third-respectively 12 and 24 months after injury. Fifty-four subjects were selected and divided into two groups: standing and non-standing. From these groups 27 pairs were made according to gender, age and height.Results:There was found to be a well-marked decrease in BMD values for lower extremities, but there was no significant difference between paraplegic and tetraplegic patients 1 and 2 year after injury. Leg BMD reduced by 19.62% (95% CI, 17-22%) in the standing group and by 24% (95% CI, 21-27%) in non-standing group during the first year. Two years after SCI patients in standing group had significantly higher leg BMD-1.018 g/cm(2) (95% CI, 0.971-1.055 g/cm(2)) than in the non-standing group-0.91 g/cm(2) (95% CI, 0.872-0.958 g/cm(2)) (P</=0.0001).Conclusion:SCI patients who performed daily standing >/=1 h and not less than 5 days per week, had significantly higher BMD in the lower extremities after 2 years in comparison to those patients who did not perform standing.Spinal Cord advance online publication, 29 April 2008; doi:10.1038/sc.2008.36.


http://www.ncbi.nlm.nih.gov/pubmed/18443599?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_RVDocSum

[stephen212]

Not to minimize the importance of having strong bones so as to benefit from any future SCI cure(s), the present risk of fracture appears to be far less than alarming.

From: Craig Hosipital web page on osteoporosis (http://www.craighospital.org/sci/mets/osteoporosis.asp)

The Good News:
The rapid bone loss that starts after your injury usually stops at about two years; people injured 30 to 40 years really don’t have any more osteoporosis than those hurt less than a decade. And, just because you have osteoporosis, it doesn’t mean you’ll have a fracture. Only about 1% to 6% of SCI persons have brittle bone-related fractures. That may seem to be a lot, but statistically the odds still are in your favor.

[Han Solo]

Are there any medications that one can take to fight losing bone density. I don't know to much about this problem so i guess an increase of calcium doesn't matter does it.

[Norm]

My Osteo numbers for one year on Vit D, Calcium, Fosamax & FES Bike. You need -2.5 too stand.

3-26-07
Right Leg -3.0
Left Leg -3.3


9-27-07
Right Leg -2.7
Left Leg -3.4


3-28-08
Right Leg -3.5
Left Leg -3.3

[wildwilly]

Not sure if there is any new information. I do not have access to full text so I had to order the article.

J Rehabil Res Dev. 2008;45(2):283-96.

Muscle and bone plasticity after spinal cord injury: Review of adaptations to disuse and to electrical muscle stimulation.

Dudley-Javoroski S, Shields RK.

Graduate Program in Physical Therapy and Rehabilitation Science, The University of Iowa, Iowa City, IA.

The paralyzed musculoskeletal system retains a remarkable degree of plasticity after spinal cord injury (SCI). In response to reduced activity, muscle atrophies and shifts toward a fast-fatigable phenotype arising from numerous changes in histochemistry and metabolic enzymes. The loss of routine gravitational and muscular loads removes a critical stimulus for maintenance of bone mineral density (BMD), precipitating neurogenic osteoporosis in paralyzed limbs. The primary adaptations of bone to reduced use are demineralization of epiphyses and thinning of the diaphyseal cortical wall. Electrical stimulation of paralyzed muscle markedly reduces deleterious post-SCI adaptations. Recent studies demonstrate that physiological levels of electrically induced muscular loading hold promise for preventing post-SCI BMD decline. Rehabilitation specialists will be challenged to develop strategies to prevent or reverse musculoskeletal deterioration in anticipation of a future cure for SCI. Quantifying the precise dose of stress needed to efficiently induce a therapeutic effect on bone will be paramount to the advancement of rehabilitation strategies.

http://www.ncbi.nlm.nih.gov/pubmed/18566946?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_RVDocSum

[jhope]

Human Growth Hormone Increases Bone Density

[antiquity]

My Osteo numbers for one year on Vit D, Calcium, Fosamax & FES Bike. You need -2.5 too stand.

3-26-07
Right Leg -3.0
Left Leg -3.3


9-27-07
Right Leg -2.7
Left Leg -3.4


3-28-08
Right Leg -3.5
Left Leg -3.3

So it's gotten worse since you've been on medication. Wow.

[poonsuzanne]

Has anyone heard of vibration to be added to the base of the standing frame to help reverse osteoporosis and/or control of bone density?

Any information will be highly appreciated!!

[donz]

I just let my legs spasm every 30 minutes or so. If I put some pressure on the muscle just above my kneecap (I do it with my thumb), my legs don't thrash around; they just stick straight out and vibrate a bit. I also use a standing frame for about an hour every night, and always keep the safety of my legs in mind during my daily activities.

Although I won't waste my time getting a bone density scan, my legs look proportionate to my body and remain under control without the aid of baclofen or other spasm-reducing meds. So far, so good.

[chasb]

Suzanne, this is a link to a topic I had posted in the exercise forum.

Whole Body Vibration Training WBV

http://sci.rutgers.edu/forum/showthread.php?t=101391

[poonsuzanne]

I just let my legs spasm every 30 minutes or so. If I put some pressure on the muscle just above my kneecap (I do it with my thumb), my legs don't thrash around; they just stick straight out and vibrate a bit. I also use a standing frame for about an hour every night, and always keep the safety of my legs in mind during my daily activities.

Although I won't waste my time getting a bone density scan, my legs look proportionate to my body and remain under control without the aid of baclofen or other spasm-reducing meds. So far, so good.

You are very lucky when you said: my legs look proportionate to my body and remain under control without the aid of baclofen or other spasm-reducing meds.

I feel so much pain to see my son with severe atrophy in his hips and legs!! Anyway, to see him live in his wheelchair every moment of the day has always been a heartbreaking experience.

[poonsuzanne]

Suzanne, this is a link to a topic I had posted in the exercise forum.

Whole Body Vibration Training WBV

http://sci.rutgers.edu/forum/showthread.php?t=101391

Chasb,

Thank you very much! I will check out the links.

[manouli]

Osteoporosis Medication Now Registered
Wednesday, 9 July 2008, 12:15 pm
Press Release: Merck Sharp and Dohme NZ


MEDICAL MEDIA RELEASE

9 July 2008

Osteoporosis Medication FOSAMAX PLUS 5600IU Now Registered

Merck Sharp & Dohme New Zealand (MSDNZ) has gained registration for its osteoporosis medication FOSAMAX PLUS™ 5600 IU.

MSDNZ Managing Director, Alister Brown, says "This will be welcome news for the many doctors who have been calling for increased Vitamin D supplementation in osteoporosis medication.

"Merck & Co has long recognised the importance of Vitamin D in improving bone health and it was the first company in the world to develop a bisphosphonate treatment containing Vitamin D – FOSAMAX PLUS 2800IU which was launched in New Zealand last year.
"Recently, treatment guidelines have recommended even higher levels of Vitamin D, which resulted in Merck & Co developing FOSAMAX PLUS 5600IU."
FOSAMAX PLUS 5600IU contains a weekly dose of two therapies – FOSAMAX™(alendronate sodium, 70mg) and Vitamin D³ (cholecalciferol, 5600 IU).

more....

http://www.scoop.co.nz/stories/GE0807/S00052.htm

[Norm]

I saw my Doc today & he prescribed Forteo.

[JenJen]

Norm, I'm starting year 2 of daily Forteo injections. Having my DEXXA on Thursday. I'll let you know if the Forteo is helping.

[Norm]

Ok great, thanx

[JenJen]

I'm going to post this in a couple of the Forteo threads. Just got back from my DEXXA scan. I've been on Forteo for one year of the 2 year protocol. Here's a little of my history as it pertains to my bone health:

46 yo caucasion female, injured 11/04, post menopausal (surgical) NO HRT as of 11/03. I have a significant pelvic obliquity that creates uneven weight distribution over my hips.

First DEXXA 1/31/06
spine 1.162 Left hip .549 Right Hip .640
Started Actonel weekly 2/06 Daily standing 5/06 (damned DME provider!)

DEXXA #2 5/24/07
spine 1.224 Left hip ..354 Right Hip ..624
Started daily Forteo injections with 6 week hiatus (due to insurance issue) No standing in 6 months.

DEXXA #3 7/17/08
spine 1.293 Left hip. .487 Right Hip .599
Will resume standing, continue Forteo and report next DEXXA :)

Hope this info is helpful for someone.

[Norm]

Am I reading this right your right hip got worse between Dexa scan 07 & 08?

[stephen212]

JenJen,

I think it would be more useful to post your T- And Z-scores, not the BMD numbers, as they are normed to your population subset.

[JenJen]

Oops sorry, I didn't see the responses until now.

Norm -- Yes my right hip did get slightly worse. It is believed that this is related to my significant pelvic obliquity.

Stephen -- I do not have the T and Z scores handy from previous tests. I'll have to get them during my next visit.

In plain English, my doctor's hope was that Forteo would slow my bone loss. Half-way through the treatment my overall bone density has improved well beyond what was expected. I am looking forward to continued improvement and I would recommend others look into Forteo. Remember there is a black box warning with Forteo that you should discuss with your doctor.

Once my Forteo therapy is complete, we are talking about the potential benefits of Reclast; which is said to promote bone growth in the long bones which is where I really need help.

[Laurance]

The following is from one of my articles posted on www.healingtherapies.info:

As summarized in two key articles, research carried out by Dr. William Bauman and colleagues, Bronx VA Medical Center indicates that individuals with SCI are often vitamin-D deficient (see Metabolism 44(12), 1995; & J Spinal Cord Med 28, 2005).

Like astronauts who lose bone density from the lack of weight-bearing activities, paralysis causes osteoporosis. As much as 50% of lower-extremity bone mass is lost during the first several years after injury, people with complete injuries losing the most. Hence, a deficiency in bone-enhancing vitamin D further aggravates an already serious SCI problem, in turn increasing fracture risk.

Bauman believes SCI predisposes one to vitamin-D deficiency for several reasons. For example, he speculates that due to limited mobility, someone with SCI may not get as much vitamin-D-producing sunlight as the general population. Supporting this idea, other scientists have demonstrated that pressure-sore-afflicted patients with SCI, who have access to the least sunlight, have the greatest vitamin-D deficiency.

Bauman also suggests that a lack maybe be caused when health-care professionals recommend reduced consumption of vitamin-D-fortified dairy products under the mistaken belief that the calcium in such foods will aggravate kidney problems. And, he believes that many SCI-associated medicines reduce the body’s vitamin-D stores.

In his 1995 study, Bauman compared vitamin-D levels in control subjects and in 100 veterans with SCI who averaged 20 years post-injury. Subjects with SCI were twice as likely to have vitamin-D levels less than that considered normal (again, the marker for vitamin-D status in the body is 25-hydroxyvitamin D produced by the liver).

In his 2005 study, Bauman examined the effectiveness of several dosing regimens in elevating vitamin-D levels in people with chronic SCI. In one regimen, 40 subjects consumed 800 IU of vitamin-D per day for 12 months. Their mean age was 43; injury duration averaged 12 years; and 17 and 23 had quadriplegia and paraplegia, respectively. Before supplementation, 33 had below-normal vitamin-D levels; in contrast, after 12 months of supplementation, only 9 remained deficient.

Although average serum vitamin-D levels doubled in subjects, Bauman believes that even greater supplementation is needed to obtain nutrient serum levels needed for promoting optimal bone health in SCI.

[Norm]

What are the best calcium pills to take? There are tons of brands.:thinking:

[Norm]

This board has a ton of info on Osteo. I hope more SCI join our voices need to be heard. C. Reeves board is a member.
http://www.inspire.com/groups/national-osteoporosis-foundation/

[manouli]

Age and motor score predict osteoprotegerin level in chronic spinal cord injury


Objective

Individuals with spinal cord injury (SCI) develop a severe form of osteoporosis below the level of injury that is poorly understood. We conducted a preliminary investigation to assess whether circulating markers of bone turnover and circulating RANKL/OPG levels are related to the severity of SCI, aging, or to differences in mobility (i.e., walking or using a wheelchair).


Methods

Sixty-four caucasian men ≥1.6 years since injury selected based on locomotive mode provided blood samples and completed a health questionnaire at the VA Boston Healthcare System from 10/2003 to 6/2005. Plasma sRANKL, osteoprotegerin (OPG), osteocalcin and carboxyterminal telopeptide of type I collagen (CTx) levels were determined.


Results
Increasing age was significantly associated with increased OPG and CTx. Injury severity was predictive of OPG levels, and adjusting for age, participants with cervical motor complete and ASIA C SCI (n=11) had significantly lower mean OPG (46.1 pg/ml) levels than others (63.4 pg/ml). Locomotive mode was not associated with differences in bone markers.


Conclusions


read...
http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2365904

[Malibu]

http://www.nytimes.com/2008/07/26/business/26amgen.html?ref=health


Drug Test a Success for Amgen


By ANDREW POLLACK (http://topics.nytimes.com/top/reference/timestopics/people/p/andrew_pollack/index.html?inline=nyt-per)
Published: July 26, 2008


Amgen (http://topics.nytimes.com/top/news/business/companies/amgen_inc/index.html?inline=nyt-org)’s experimental bone drug, widely considered to be crucial to the company’s future, has succeeded in its most important clinical trial, sending the company’s shares up sharply.



Denosumab had already been shown in smaller studies to build bone mineral density. But there was a question of whether that would translate into a strong reduction in the risk of fractures, which the Food and Drug Administration (http://topics.nytimes.com/top/reference/timestopics/organizations/f/food_and_drug_administration/index.html?inline=nyt-org) regards as the most relevant measure of an osteoporosis drug.



While most analysts and doctors expected a reduction in spinal fractures, the main goal of the trial, there was some surprise that denosumab also reduced hip fractures, which are costly and potentially lethal medical problems. Hip fractures are rarer than spine fractures, making it more difficult to show a statistically significant effect.



Denosumab is a monoclonal antibody that blocks the action of RANK ligand, a protein that plays a fundamental role in how bones are continuously broken down and rebuilt.



While many drugs are based on academic discoveries, Amgen itself discovered the role of RANK ligand in the 1990s. The Amgen scientists were studying the effects of different genes in mice and found some animals with particularly dense bones, setting off a search for the mechanism involved.


“This was probably one of the greatest discoveries in bone physiology,” said Dr. J. Christopher Gallagher, professor and director of the bone metabolism section at Creighton University.

[Wise Young]

http://www.nytimes.com/2008/07/26/business/26amgen.html?ref=health


Drug Test a Success for Amgen


By ANDREW POLLACK (http://topics.nytimes.com/top/reference/timestopics/people/p/andrew_pollack/index.html?inline=nyt-per)
Published: July 26, 2008


Amgen (http://topics.nytimes.com/top/news/business/companies/amgen_inc/index.html?inline=nyt-org)’s experimental bone drug, widely considered to be crucial to the company’s future, has succeeded in its most important clinical trial, sending the company’s shares up sharply.

Thanks for posting this. It is very welcome news.

Wise.

[Norm]

I can't believe my Insurance co. is debating behind the scenes on whether to let me take Forteo. There must not be enough data out there to prove the case. SCI researchers are not making Osteo part of the standard maintenance care for people with SCI. :thinking:

[wildwilly]

Spinal Cord. 2008 Aug 19.

Physiatrists' opinions and practice patterns for bone health after SCI.

Ashe MC, Eng JJ, Krassioukov A.

[1] 1Rehabilitation Research Lab, GF Strong Rehabilitation Centre, Vancouver, British Columbia, Canada [2] 2Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.

Study design:Self-report surveyObjective:To ascertain physiatrists' opinions and current practice patterns for bone health management after spinal cord injury (SCI).Participants:Physiatrists who work in teaching rehabilitation centers in Canada.Methods:A 4-page 17-question survey (available in French and English) was sent to working physiatrists in all major Canadian SCI rehabilitation centers.Results:We had an 85% response rate (22 responses). Physiatrists reported that they should be managing bone health issues after SCI in conjunction with family physicians, and most respondents assess and treat for bone health after SCI. However, just over one-third of the physiatrists reported that the current treatment options are not effective for low bone mass; there was more support for pharmacological treatments than there was for rehabilitation modalities.Conclusion:Bone health after SCI is an important health concern that is being managed by physiatrists; however, more discussion and research is needed to ascertain the effectiveness of assessment and treatment options for low bone mass.Spinal Cord advance online publication, 19 August 2008; doi:10.1038/sc.2008.104.



Osteoporos Int. 2008 Jun 26.

Osteoporotic fractures and hospitalization risk in chronic spinal cord injury.

Morse LR, Battaglino RA, Stolzmann KL, Hallett LD, Waddimba A, Gagnon D, Lazzari AA, Garshick E.

Department of Physical Medicine and Rehabilitation, Harvard Medical School and Spaulding Rehabilitation Hospital, Boston, MA, USA, lmorse4@partners.org.

Osteoporosis is a well acknowledged complication of spinal cord injury. We report that motor complete spinal cord injury and post-injury alcohol consumption are risk factors for hospitalization for fracture treatment. The clinical assessment did not include osteoporosis diagnosis and treatment considerations, indicating a need for improved clinical protocols. INTRODUCTION: Treatment of osteoporotic long bone fractures often results in lengthy hospitalizations for individuals with spinal cord injury. Clinical features and factors that contribute to hospitalization risk have not previously been described. METHODS: Three hundred and fifteen veterans >/= 1 year after spinal cord injury completed a health questionnaire and underwent clinical exam at study entry. Multivariate Cox regression accounting for repeated events was used to assess longitudinal predictors of fracture-related hospitalizations in Veterans Affairs Medical Centers 1996-2003. RESULTS: One thousand four hundred and eighty-seven hospital admissions occurred among 315 participants, and 39 hospitalizations (2.6%) were for fracture treatment. Median length of stay was 35 days. Fracture-related complications occurred in 53%. Independent risk factors for admission were motor complete versus motor incomplete spinal cord injury (hazard ratio = 3.73, 95% CI = 1.46-10.50). There was a significant linear trend in risk with greater alcohol consumption after injury. Record review indicated that evaluation for osteoporosis was not obtained during these admissions. CONCLUSIONS: Assessed prospectively, hospitalization in Veterans Affairs Medical Centers for low-impact fractures is more common in motor complete spinal cord injury and is associated with greater alcohol use after injury. Osteoporosis diagnosis and treatment considerations were not part of a clinical assessment, indicating the need for improved protocols that might prevent low-impact fractures and related admissions.

http://www.ncbi.nlm.nih.gov/pubmed/18581033?ordinalpos=5&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_RVDocSum

[poonsuzanne]

Suzanne, this is a link to a topic I had posted in the exercise forum.

Whole Body Vibration Training WBV

http://sci.rutgers.edu/forum/showthread.php?t=101391


Chasb, thanks again!!

As I read the link it did not mention WBV anything related to osteoporosis in SCI. Also, I have consulted a renowned SCI research in Vancouver, he said he did not see shaking your body would do anything good for osteoporosis in SCI.

[Wise Young]

Effect of Vibration on Bone Density
Wise Young, Ph.D., M.D.
W. M. Keck Center for Collaborative Neuroscience
Rutgers University, Piscataway, NJ
28 August 2008

Many investigators have speculated that vibration may stimulate bone formation [8]. Unfortunately, until recently, few studies have been carried out. Several recent studies suggested whole body vibration may improve bone mineral density (BMD). Let me review these findings.

In 2005, Iwamoto, et al. [3] studied the effects of whole-body vibration exercise on mineral density, bone turnover, and chronic back pain in 50 post-menopausal osteoporotic women. The women ranged in age from 55-88 years old and randomized into two groups, one taking alendronate (5 mg daily) and the other taking alendronate plus vibration. The vibrtion was done with a Novotec Galileo (Pforzheim, Germany) at an intensity of 20 Hz, once a week for 4 minutes. [By the way, I was amazed by how little the vibration time was and why they would expect anything to work with such a low dose]. They measured lumbar BMD with x-ray absorptiometry and alkaline phosphatase (AP). The study showed that whole body vibration significantly reduced back pain in the vibrated group compared to the drug only group. There was no difference in BMD.

In 2006, Gusi, et al. [2] compred two marketed vibrating platforms, one of which oscillates up and down and the other goes left and right. They took 28 post-menopausal women assigned to whole body vibration (6 bouts of 1 minute, 12.6 Hz, 3 cm amplitude, 60 degrees of knee flexion with one minute rests between bouts) or to walking sessions of 55 minutes with 5 minute stretching. After 8 months, BMD of the femoral neck in the whole body vibrated group significantly increased, compard to the walking group. In contrast, the BMD of the lumbar spine was unaltered in both groups. The authors concluded that vibratory “exercise” suing a reciprocating plate is feasibl and more effetive than walking in improving hip BMD and balance.

In 2007, Cardinale, et al. [1] reported whole-body vibration reduces calciuria induced by high protein intakes and may counteract bone resorption. This study, done in England, examined 10 healthy 22-29 year old individuals. They were vibrated for 10 minutes a day at 3.5 g and 30 Hz plate on which they stood. Daily urine samples showed that high protein caused urinary excretion of calcium. However, vibrational stimuli significantly reduced the calcium output in urine. Note that this may not occur in people with spinal cord injury but this is an interesting experimental design and it appears to be sensitive to 10 minutes of vibrational exposure per day.

Vibrational therapy may have other beneficial effects. Lohman, et al. [4] reported that whole body vibration improved lower extremity skin blood flow in normal subjects. Semler, et al. [6] studied the effects of whole body vibration in six immobilized children and adolescents in Cologne, Germany. They had a variety ofproblems ranging from osteogenesis imperfecta (n=4), cerebral palsy (n=1), spina bifida (n=1). The vibration was applied with a Galileo to the patients on a tilt table, applied daily of 6 months. At the end of the period, all 6 individuals had improved mobility, documented by improved tilt-angle or better BAMF score. In a followup study, Semler, et al. [7] concluded that whole body vibration is a promising approach to improve mobility in children and adolescents with osteogenesis imperfecta.

In 2007, Melchiorri, et al. [5] published a study of vibrational exercise on spinal cord injury patients who regularly practice sports. Ten volunteers were tested, with vibration applied during forearm flexion in isometric condition daily for 6 months. They maeaured FIM (functional independence measure), fat, BMD, and other measures. They found a significant beneficial effect of vibrational therapy on average velocity and average power of forearm flexion. Bone density measurements were higher but did not reach statistical significance. So, while the data is not yet convincing that whole body vibration therapy is beneficial for BMD or function in people with spinal cord injury, several studies suggest that the treatment may help.

References

1. Cardinale M, Leiper J, Farajian P and Heer M (2007). Whole-body vibration can reduce calciuria induced by high protein intakes and may counteract bone resorption: A preliminary study. J Sports Sci. 25: 111-9. Olympic Medical Institute, Northwick Park Hospital, Harrow, UK. Marco.Cardinale@boa.org.uk. Excess protein intake can adversely affect the bone via an increase in calcium excretion, while suitable mechanical loading promotes osteogenesis. We therefore investigated whether vibration exposure could alleviate the bone mineral losses associated with a metabolic acidosis. Ten healthy individuals aged 22 - 29 years (median = 25) underwent three 5-day study periods while monitoring their dietary intake. The study consisted of recording the participants' usual dietary intake for 5 consecutive days. Participants were then randomly divided into two groups, one of which received a protein supplement (2 g x kg(-1) body mass x day(-1); n = 5) and the other whole-body low-magnitude (3.5 g), low-frequency (30 Hz) mechanical vibration (WBV) delivered through a specially designed vibrating plate for 10 min each day (n = 5). Finally, for the third treatment period, all participants consumed the protein supplement added to their normal diet and were exposed to WBV exercise for 10 min per day. Daily urine samples were collected throughout the experimental periods to determine the excretion of calcium, phosphate, titratable acid, urea, and C-telopeptide. As expected, when the participants underwent the high protein intake, there was an increase in urinary excretion rates of calcium (P < 0.001), phosphate (P < 0.003), urea (P < 0.001), titratable acid (P < 0.001), and C-telopeptide (P < 0.05) compared with baseline values. However, high protein intake coupled with vibration stimulation resulted in a significant reduction in urinary calcium (P = 0.006), phosphate excretion (P = 0.021), and C-telopeptide (P < 0.05) compared with protein intake alone, but did not affect titratable acid and urea output. The participants showed no effect of WBV exercise alone on urinary excretion of calcium, phosphate, urea, titratable acid, or C-telopeptide. The results indicate that vibration stimulation can moderate the increase in bone resorption and reduction in bone formation caused by a metabolic acidosis.
2. Gusi N, Raimundo A and Leal A (2006). Low-frequency vibratory exercise reduces the risk of bone fracture more than walking: a randomized controlled trial. BMC Musculoskelet Disord. 7: 92. Faculty of Sports Sciences, University of Extremadura, Caceres, Spain. ngusi@unex.es. BACKGROUND: Whole-body vibration (WBV) is a new type of exercise that has been increasingly tested for the ability to prevent bone fractures and osteoporosis in frail people. There are two currently marketed vibrating plates: a) the whole plate oscillates up and down; b) reciprocating vertical displacements on the left and right side of a fulcrum, increasing the lateral accelerations. A few studies have shown recently the effectiveness of the up-and-down plate for increasing Bone Mineral Density (BMD) and balance; but the effectiveness of the reciprocating plate technique remains mainly unknown. The aim was to compare the effects of WBV using a reciprocating platform at frequencies lower than 20 Hz and a walking-based exercise programme on BMD and balance in post-menopausal women. METHODS: Twenty-eight physically untrained post-menopausal women were assigned at random to a WBV group or a Walking group. Both experimental programmes consisted of 3 sessions per week for 8 months. Each vibratory session included 6 bouts of 1 min (12.6 Hz in frequency and 3 cm in amplitude with 60 degrees of knee flexion) with 1 min rest between bouts. Each walking session was 55 minutes of walking and 5 minutes of stretching. Hip and lumbar BMD (g.cm-2) were measured using dual-energy X-ray absorptiometry and balance was assessed by the blind flamingo test. ANOVA for repeated measurements was adjusted by baseline data, weight and age. RESULTS: After 8 months, BMD at the femoral neck in the WBV group was increased by 4.3% (P = 0.011) compared to the Walking group. In contrast, the BMD at the lumbar spine was unaltered in both groups. Balance was improved in the WBV group (29%) but not in the Walking group. CONCLUSION: The 8-month course of vibratory exercise using a reciprocating plate is feasible and is more effective than walking to improve two major determinants of bone fractures: hip BMD and balance.
3. Iwamoto J, Takeda T, Sato Y and Uzawa M (2005). Effect of whole-body vibration exercise on lumbar bone mineral density, bone turnover, and chronic back pain in post-menopausal osteoporotic women treated with alendronate. Aging Clin Exp Res. 17: 157-63. Department of Sports Medicine, Keio University School of Medicine, Tokyo, Japan. jiwamoto@sc.itc.keio.ac.jp. BACKGROUND AND AIMS: Exercise may enhance the effect of alendronate on bone mineral density (BMD) and reduce chronic back pain in elderly women with osteoporosis. The aim of this study was to determine whether whole-body vibration exercise would enhance the effect of alendronate on lumbar BMD and bone turnover, and reduce chronic back pain in postmenopausal women with osteoporosis. METHODS: Fifty post-menopausal women with osteoporosis, 55-88 years of age, were randomly divided into two groups of 25 patients each: one taking alendronate (5 mg daily, ALN) and one taking alendronate plus exercise (ALN+EX). Exercise consisted of whole-body vibration using a Galileo machine (Novotec, Pforzheim, Germany), at an intensity of 20 Hz, frequency once a week, and duration of exercise 4 minutes. The study lasted 12 months. Lumbar BMD was measured by dual energy X-ray absorptiometry (Hologic QDR 1500W). Urinary cross-linked N-terminal telopeptides of type I collagen (NTX) and serum alkaline phosphatase (ALP) levels were measured by enzyme-linked immunosorbent assay and standard laboratory techniques, respectively. Chronic back pain was evaluated by face scale score at baseline and every 6 months. RESULTS: There were no significant differences in baseline characteristics, including age, body mass index, years since menopause, lumbar BMD, urinary NTX and serum ALP levels, or face scale score between the two groups. The increase in lumbar BMD and the reduction in urinary NTX and serum ALP levels were similar in the ALN and ALN+EX groups. However, the reduction in chronic back pain was greater in the ALN+EX group than in the ALN group. CONCLUSIONS: The results of this study suggest that whole-body vibration exercise using a Galileo machine appears to be useful in reducing chronic back pain, probably by relaxing the back muscles in post-menopausal osteoporotic women treated with alendronate.
4. Lohman EB, 3rd, Petrofsky JS, Maloney-Hinds C, Betts-Schwab H and Thorpe D (2007). The effect of whole body vibration on lower extremity skin blood flow in normal subjects. Med Sci Monit. 13: CR71-6. Department of Physical Therapy, Loma Linda University, Loma Linda, CA 92350, USA. elohman@llu.edu. BACKGROUND: Circulation plays a vital role in tissue healing. Increases in muscle flexibility and strength, secretion of hormones important in the regeneration and repair process, blood flow, and strength of bone tissues has been attributed to whole body vibration (WBV) combined with exercise. The purpose of the study was to determine the effects of short-duration, high-intensity, isometric weight bearing exercise (vibration exercise [VE]) and vibration only on skin blood flow (SBF). MATERIAL/METHODS: Forty-five subjects 18-43 years of age were randomly divided into three groups: Group 1 - VE, Group 2 - exercise only, and Group 3 - vibration only. SBF was measured using a laser Doppler imager at three time intervals: 1) initial base line, 2) immediately following intervention, and 3) 10-minutes following intervention. RESULTS: There was no significant difference between the three groups' SBF prior to intervention. Immediately following the intervention a difference among groups was found. Post hoc testing revealed that Group 3 subjects' mean SBF was significantly increased at both post-intervention time intervals. CONCLUSION: The study findings suggest that short duration vibration alone significantly increases SBF; doubling mean SBF for a minimum of 10 minutes following intervention. The emerging therapeutic modality of WBV as a passive intervention appears to increase SBF in individuals with healthy microcirculation.
5. Melchiorri G, Andreoli A, Padua E, Sorge R and De Lorenzo A (2007). Use of vibration exercise in spinal cord injury patients who regularly practise sport. Funct Neurol. 22: 151-4. Degree Course in Sports Sciences, Faculty of Medicine, University of Rome Tor Vergata, Italy. giovannimelchiorri@virgilio.it. The aim of this study was to evaluate the applicability and effects of mechanical vibration on body composition and mechanical properties of the arm in patients with spinal cord injury (SCI). For this purpose, ten volunteers with thoracic SCI were recruited. Measurements were performed before and after a period of treatment with mechanical vibration applied during forearm flexion in isometric condition. The subjects were tested performing forearm flexion (both right and left side) with increasing loads, corresponding to 5, 8, 10 and 15% of their own body weight. Average velocity (AV), average force (AF) and average power (AP) were calculated. The Functional Independence Measure was used to evaluate daily autonomy at baseline. Total body and segmental (arms) body composition, fat mass, fat-free mass, and bone mineral density, were studied by dual energy X-ray absorptiometry. Functional measurements (AV, AF, AP) and body composition were measured at three time points: after a medical examination and interview (T0); after an interval of 12 weeks without physical therapy or training (T1); and finally after a further 12-week period during which the patients performed segmental vibration exercise (T2). The results showed statistically significant increases in AV and AP on the right (dominant) side (p<0.05); AF also increased, but without the difference reaching statistical significance. Total body composition, did not change whereas the bone mineral density of the arms was higher after treatment, but again without the difference reaching statistical significance.
6. Semler O, Fricke O, Vezyroglou K, Stark C and Schoenau E (2007). Preliminary results on the mobility after whole body vibration in immobilized children and adolescents. J Musculoskelet Neuronal Interact. 7: 77-81. Children's Hospital, University of Cologne, Cologne, Germany. The present article is a preliminary report on the effect of Whole Body Vibration (WBV) on the mobility in long-term immobilized children and adolescents. WBV was applied to 6 children and adolescents (diagnoses: osteogenesis imperfecta, N=4; cerebral palsy, N=1; dysraphic defect of the lumbar spine, N=1) over a time period of 6 months. WBV was applied by a vibrating platform constructed on a tilt-table. The treatment effect was measured by alternations of the tilt-angle of the table and with the "Brief assessment of motor function" (BAMF). All 6 individuals were characterized by an improved mobility, which was documented by an increased tilt-angle or an improved BAMF-score. The authors concluded WBV might be a promising approach to improve mobility in severely motor-impaired children and adolescents. Therefore, the Cologne Standing-and-Walking- Trainer powered by Galileo is a suitable therapeutic device to apply WBV in immobilized children and adolescents.
7. Semler O, Fricke O, Vezyroglou K, Stark C, Stabrey A and Schoenau E (2008). Results of a prospective pilot trial on mobility after whole body vibration in children and adolescents with osteogenesis imperfecta. Clin Rehabil. 22: 387-94. Children's Hospital, University of Cologne, Cologne, Germany. OBJECTIVE: To evaluate the effect of whole body vibration on the mobility of long-term immobilized children and adolescents with a severe form of osteogenesis imperfecta. Osteogenesis imperfecta is a hereditary primary bone disorder with a prevalence from 1 in 10000 to 1 in 20000 births. Most of these children are suffering from long-term immobilization after recurrent fractures. Due to the immobilization they are affected by loss of muscle (sarcopenia) and secondary loss of bone mass. SUBJECTS: Whole body vibration was applied to eight children and adolescents (osteogenesis imperfecta type 3, N=5; osteogenesis imperfecta type 4, N=3) over a period of six months. INTERVENTIONS AND RESULTS: Whole body vibration was applied by a vibrating platform (Galileo Systems) constructed on a tilting-table. Success of treatment was assessed by measuring alterations of the tilting-angle and evaluating the mobility (Brief Assessment of Motor Function). All individuals were characterized by improved muscle force documented by an increased tilting-angle (median = 35 degrees) or by an increase in ground reaction force (median at start=30.0 [N/kg] (14.48-134.21); median after six months = 146.0 [N/kg] (42.46-245.25). CONCLUSIONS: Whole body vibration may be a promising approach to improve mobility in children and adolescents severely affected with osteogenesis imperfecta.
8. Yoshimura T, Nakai K and Tamaoki G (2005). Multi-body dynamics modelling of seated human body under exposure to whole-body vibration. Ind Health. 43: 441-7. Mechanical Engineering Department, Tokyo Metropolitan University, 1-1, Minami-Osawa, Hachioji-shi, Tokyo 192-0397, Japan. In vehicle systems occupational drivers might expose themselves to vibration for a long time. This may cause illness of the spine such as chronic lumbago or low back pain. Therefore, it is necessary to evaluate the influence of vibration to the spinal column and to make up appropriate guidelines or counter plans. In ISO2631-1 or ISO2631-5 assessment of vibration effects to human in the view of adverse-health effect was already presented. However, it is necessary to carry out further research to understand the effect of vibration to human body to examine their validity and to prepare for the future revision. This paper shows the detail measurement of human response to vibration, and the modelling of the seated human body for the assessment of the vibration risk. The vibration transmissibilities from the seat surface to the spinal column and to the head are measured during the exposure to vertical excitation. The modal paramters of seated subject are extracted in order to understand the dominant natural modes. For the evaluation of adverse-health effect the multi-body modelling of the spinal column is introduced. A simplified model having 10 DOFs is counstructed so that the transmissibilities of the model fit to those of experiment. The transient response analysis is illustrated when a half-sine input is applied. The relative displacements of vertebrae are evaluated, which can be a basis for the assessment of vibration risk. It is suggested that the multi-body dynamic model is used to evaluate the vibration effect to the spinal column for seated subjects.

[Norm]

Still no decision on my Forteo. I sure wish there was more documentation on the need for SCI to have a normal Dexa scan & the need for bone building drugs for those that need them. I have a feeling my insurance is going to stiff me because of the lack of data. :mad:

[poonsuzanne]

[QUOTE=Malibu]http://www.nytimes.com/2008/07/26/business/26amgen.html?ref=health


Drug Test a Success for Amgen


Thank you very much for posting about the new drug!!

[I Care]

But be careful, do research on these drugs before you decide, please! Read the warnings and take them very seriously.



Fosamax® is a bisphosphonate medication used for bone loss. Users of Fosamax have suffered Osteonecrosis of the Jaw, also known as Jaw Necrosis, ONJ, Bis-Phossy Jaw or Dead Jaw. This painful and disfiguring condition causes the jaw bone to decay and die. Symptoms of osteonecrosis may lead to infection of the jaw and exposed portions of bone inside the mouth. Merck, the manufacturer of Fosamax, failed to warn users of this side effect. Similar problems have been linked to Fosamax's bisphosphonate competitor, Actonel, which is marketed by Procter & Gamble.
Other similar bisphosphonates have also been implicated in the serious necrosis of the jaw. In the U.S. Package Insert for both Aredia and Zometa, the following information on osteonecrosis had previously been added to the Adverse Reactions section under Post-Marketing Experience:
"Cases of osteonecrosis (primarily involving the jaws) have been reported in patients treated with bisphosphonates. The majority of the reported cases are in cancer patients attendant to a dental procedure. Osteonecrosis of the jaw has multiple well documented risk factors including a diagnosis of cancer, concomitant therapies (e.g., chemotherapy, radiotherapy, corticosteroids) and co-morbid conditions (e.g., anemia, coagulopathies, infection, pre-existing oral disease). Although causality cannot be determined, it is prudent to avoid dental surgery as recovery may be prolonged."
http://www.levinlaw.com/CM/UploadedImages/102339.jpgLevin Papantonio is investigating claims and Fosamax lawsuits nationwide for Fosamax users who have suffered damage to their jaw bone as a result of the popular medication. If you have been injured by Fosamax, Actonel , Aredia, or Zometa, contact our Fosamax Attorneys for a free legal consultation (http://www.levinlaw.com/PracticeAreas/Personal-Injury-Intake-Form.asp). You may be entitled to compensation for a jaw bone injury which could have been prevented.
Fosamax® Links about Osteonecrosis from bisphosphonate medications for bone loss:

Side Effect Watch: Femur Fractures in Fosamax Patients
(http://blogs.wsj.com/health/2008/06/04/side-effect-watch-femur-fractures-in-fosamax-patients/)A study in the current issue of the Journal of Orthopedic Trauma links Merck's osteoporosis drug Fosamax to a rare type of fracture in the femur.
Suit Alleges Merck Negligently Promoted Osteoporosis Drug Fosamax (http://www.law.com/jsp/article.jsp?id=1144845718630)
Merck & Co., which is already facing a raft of cases over its pain reliever Vioxx, may need to hire additional attorneys to fight a recently filed lawsuit alleging the company was negligent in promoting its osteoporosis drug Fosamax.
Oral Surgeon Warns about "bis-phossy jaw" (http://sev.prnewswire.com/health-care-hospitals/20050506/CGTH06205052005-1.html)
Bisphosphonates, a class of drugs taken by millions of patients for osteoporosis and bone-related complications of metastatic cancer may actually contribute to the onset of osteochemonecrosis, or "bis-phossy jaw," a painful, potentially disfiguring jaw condition, according to an article published in the May issue of the Journal of Oral and Maxillofacial Surgery.
Wall Street Journal says industry moving slowly on dead jaw problems (http://online.wsj.com/public/resources/documents/SB110245057172293526.htm)
After eight operations on patients whose jawbones turned out to be dead, oral surgeon Salvatore Ruggiero began doing some research in February 2001. He scoured the patients' medical records and discovered they had something in common: They were cancer patients taking a drug called Aredia to combat bone loss...
USA Today - Dead Jawbones linked to drug (http://www.usatoday.com/news/health/2005-03-13-jawbone-deaths_x.htm)
Over a three-year period, the jaws of dozens of patients who had undergone oral surgery at his hospital had failed to heal properly. Part of the jawbone had died and become exposed.
Biphosphonates and Jaw Necrosis (http://www.cancerpage.com/news/article.asp?id=8122)
Cancer patients given drugs called bisphosphonates to control hypercalcemia – too much calcium in the blood – or the growth of bone metastases can develop bone death in the jaw the FDA warns.
Novartis Letter warns about its drugs causing osteonecrosis (http://www.levinlaw.com/PracticeAreas/Novaris-letter.pdf)
Novartis is fully committed to assuring timely dissemination of safety information about their products to the healthcare community. We are writing to inform you of changes made to the Precautions and Post-Marketing Experience

[Arwen]

Does any one know about vibration to help prevent osteoporosis? My dad read an article about research NASA was doing to help astronauts...I stand on a plate that was meant to be a foot massager a couple times a week. Not sure how much of a difference it's making, but my doctors say it won't hurt...and makes intuitive sense.

[poonsuzanne]

But be careful, do research on these drugs before you decide, please! Read the warnings and take them very seriously.

Thanks! I will be careful but really am looking for something to help my injured son.

http://www.nytimes.com/2008/07/26/bu...tml?ref=health

About 44 million Americans over the age of 50 have osteoporosis, or low bone mass, according to the National Osteoporosis Foundation. The main drugs used now, called bisphosphonates, include Fosamax, Boniva from Roche and GlaxoSmithKline, and Actonel from Procter & Gamble and Sanofi-Aventis.

These drugs are difficult for some people to take because they can irritate the esophagus. People are supposed to take them first thing in the morning with a glass of water, then remain upright without eating or drinking for at least 30 minutes. The drugs also accumulate in the bone, and recently some concerns have arisen about rare side effects from long-term use of the drugs, like a rotting of jaw bones.

Denosumab works by a different mechanism and is given by injection once every six months, while the bisphosphonate pills are taken daily, weekly or monthly.

[poonsuzanne]

The following is from one of my articles posted on www.healingtherapies.info:

In his 2005 study, Bauman examined the effectiveness of several dosing regimens in elevating vitamin-D levels in people with chronic SCI. In one regimen, 40 subjects consumed 800 IU of vitamin-D per day for 12 months. Their mean age was 43; injury duration averaged 12 years; and 17 and 23 had quadriplegia and paraplegia, respectively. Before supplementation, 33 had below-normal vitamin-D levels; in contrast, after 12 months of supplementation, only 9 remained deficient.

Although average serum vitamin-D levels doubled in subjects, Bauman believes that even greater supplementation is needed to obtain nutrient serum levels needed for promoting optimal bone health in SCI.

I am wondering whether 'Forteo' or 'FOSAMAX PLUS 5600IU' is the right medication for SCI!!!

[new dimension]

My 20 year old son 8 months out was recently told he has ostoepenia in the lumbar region and it has been recommended to take fosomax. Apparently bone loss starts 14 days after such and accident. Not to excited about taking another drug with all the side effects....but what is one to do ..we hope to see an osteopath to address the vitamin needs asap and the osteopenia with naturally as possible.

Have to be careful with supplements causing kidney stones

[poonsuzanne]

My 20 year old son 8 months out was recently told he has ostoepenia in the lumbar region and it has been recommended to take fosomax. Apparently bone loss starts 14 days after such and accident. Not to excited about taking another drug with all the side effects....but what is one to do ..we hope to see an osteopath to address the vitamin needs asap and the osteopenia with naturally as possible.

Have to be careful with supplements causing kidney stones

Thanks!!! I will definitely be careful. But I really want to help my son with everything I can.

[poonsuzanne]

Age and motor score predict osteoprotegerin level in chronic spinal cord injury


Objective

Individuals with spinal cord injury (SCI) develop a severe form of osteoporosis below the level of injury that is poorly understood. We conducted a preliminary investigation to assess whether circulating markers of bone turnover and circulating RANKL/OPG levels are related to the severity of SCI, aging, or to differences in mobility (i.e., walking or using a wheelchair).


Methods

Sixty-four caucasian men ≥1.6 years since injury selected based on locomotive mode provided blood samples and completed a health questionnaire at the VA Boston Healthcare System from 10/2003 to 6/2005. Plasma sRANKL, osteoprotegerin (OPG), osteocalcin and carboxyterminal telopeptide of type I collagen (CTx) levels were determined.


Results
Increasing age was significantly associated with increased OPG and CTx. Injury severity was predictive of OPG levels, and adjusting for age, participants with cervical motor complete and ASIA C SCI (n=11) had significantly lower mean OPG (46.1 pg/ml) levels than others (63.4 pg/ml). Locomotive mode was not associated with differences in bone markers.


Conclusions


read...
http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2365904

In the conclusion of the above article it said:

"While bone loss is most rapid in the first 2 years following spinal cord injury, the mean time to first fracture is nine years post-injury. Seventy-six percent of patients will sustain a traumatic fracture at some point following their injury."

However in the article from HealthResources@craighospital.org it said:

"The Good News: Only about 1% to 6% of SCI persons have brittle bone-related fractures. That may seem to be a lot, but statistically the odds still are in your favor."

So, indeed, what should be the percentage of patients who will sustain a traumatic fracture after SCI?

In the same article from HealthResources@craighospital.org it also said:

"Spasticity: Spasms exert force on bones. Like weight-bearing, this should maintain bone strength. However, at the same time, spasms themselves have caused bones to break. The message here is that some spasticity is good; too much is bad."

[poonsuzanne]

Effect of Vibration on Bone Density
Wise Young, Ph.D., M.D.
W. M. Keck Center for Collaborative Neuroscience
Rutgers University, Piscataway, NJ
28 August 2008


Dr. Young,

Many thanks for posting this informative summary!! What you concluded was that the data collected in the studies is not yet convincing that whole body vibration therapy is beneficial for BMD (bone mineral density) or function in people with SCI.

[poonsuzanne]

I will buy this one for my son:

In Vienna, Stimulette r4x from www.schuhfriedmed.at will be available for sale on the market in approximately 2 months. The new device has four channels in one unit. This means you can stimulate 4 muscle groups at one time with the same intensity of each channel. At the moment, they are selling a 2 channel unit. In 2005, they were selling a unit with one channel only.

I believe this is the best PFES for SCI!!

[-scott-]

Thanks!!! I will definitely be careful. But I really want to help my son with everything I can. Suzanne - Fosamax also has the potential to open more possibilities for micro fractures b/c, if I understand correctly, it stunts the osteoclasts, which extract calcium from the bone during the bone production process, which ultimately leads to decreased tensile strength. Fosamax also hinders the ability to produce blood vessels in the bone somehow or another. I don't recall what article referenced these side effects but I'll see if I can dig it up when I have time.

edit: it may be referenced on the previous page.. haven't read through the links "I Care" posted yet

[poonsuzanne]

Suzanne - Fosamax also has the potential to open more possibilities for micro fractures b/c, if I understand correctly, it stunts the osteoclasts, which extract calcium from the bone during the bone production process, which ultimately leads to decreased tensile strength. Fosamax also hinders the ability to produce blood vessels in the bone somehow or another. I don't recall what article referenced these side effects but I'll see if I can dig it up when I have time.

edit: it may be referenced on the previous page.. haven't read through the links "I Care" posted yet

Scott, thanks again!

Sometimes I want to scream, God please help my son, God please tell me what to do!!!

[wildwilly]

J Musculoskelet Neuronal Interact. 2008 Jul-Sep;8(3):227-38.

Asymmetric bone adaptations to soleus mechanical loading after spinal cord injury.

Dudley-Javoroski S, Shields RK.

Graduate Program in Physical Therapy and Rehabilitation Science, The University of Iowa, Iowa City, IA, USA.

The purpose of this report is to examine longitudinal bone mineral density (BMD) changes in individuals with spinal cord injury (SCI) who began unilateral soleus electrical stimulation early after injury. Twelve men with SCI and seven without SCI underwent peripheral quantitative computed tomography assessment of distal tibia BMD. After 4.5 to 6 years of training, average trained limb BMD was 27.5% higher than untrained limb BMD. The training effect was more pronounced in the central core of the tibia cross-section (40.5% between-limb difference). No between-limb difference emerged in the anterior half of the tibia (19.2 mg/cm(3) difference, p>0.05). A robust between-limb difference emerged in the posterior half of the tibia (76.1 mg/cm(3) difference, p=0.0439). The posterior tibia BMD of one subject remained within the range of non-SCI values for 3.8 years post-SCI. The results support that the constrained orientation of soleus mechanical loads, administered over several years, elicited bone-sparing effects in the posterior tibia. This study provides a demonstration of the bone-protective potential of a carefully controlled dose of mechanical load. The specific orientation of applied mechanical loads may strongly influence the manifestation of BMD adaptations in humans with SCI.

http://www.ncbi.nlm.nih.gov/pubmed/18799855?ordinalpos=2&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum

[Dr_John]

I'm trying to understand how to accelerate bone repair in some microfractures I have, and I ran across some medical lit on cissus quadrangularis. While I'm a medical research type, I don't dismiss traditional cultural medicines but I am skeptical of the western need to make a profit on unregulated herbs (etc) and leary of quality an authenticity.

Given all that I am intrigued by cissus, it is a tradtional Indian herb used for bone healing and it seems that it (at least) has interesting forms of calcium

"the calcite crystals obtained from C. quadrangularis plant extract is significantly different from the one normally observed for calcite"

From: Calcite growth in Cissus
quadrangularis plant extract, a
traditional Indian bone-healing aid

Ambarish Sanyal, Absar Ahmad and
Murali Sastr

Other lit suggests this has anti inflammatory and anabolic effects, so I was able to find some via bodybuilding sales places that claimed 'standardized' versions (I guess these types are looking for anything anabolic). There is a fair amount of research lit coming out of peer reviewed Indian journals, enough so the I've decided the preponderance of evidence warrents my experimenting with it.

I was wondering if anyone in this forum had heard of it. I would be cautious about mixing this with other bone density enhancing scripts, because I don't know the metabolic pathyways.

Any opinions appreciated.

-john

[Norm]

My Insurance Co. came to their senses after 3 months of waiting. They are now paying for Forteo. But only for six months. To see if it works. I started my first injection on tuesday.

[JGNI]

I'm trying to understand how to accelerate bone repair in some microfractures I have, and I ran across some medical lit on cissus quadrangularis. While I'm a medical research type, I don't dismiss traditional cultural medicines but I am skeptical of the western need to make a profit on unregulated herbs (etc) and leary of quality an authenticity.

Given all that I am intrigued by cissus, it is a tradtional Indian herb used for bone healing and it seems that it (at least) has interesting forms of calcium

"the calcite crystals obtained from C. quadrangularis plant extract is significantly different from the one normally observed for calcite"

From: Calcite growth in Cissus
quadrangularis plant extract, a
traditional Indian bone-healing aid

Ambarish Sanyal, Absar Ahmad and
Murali Sastr

Other lit suggests this has anti inflammatory and anabolic effects, so I was able to find some via bodybuilding sales places that claimed 'standardized' versions (I guess these types are looking for anything anabolic). There is a fair amount of research lit coming out of peer reviewed Indian journals, enough so the I've decided the preponderance of evidence warrents my experimenting with it.

I was wondering if anyone in this forum had heard of it. I would be cautious about mixing this with other bone density enhancing scripts, because I don't know the metabolic pathyways.

Any opinions appreciated.

-john

Any update on your experiments John?

[wildwilly]

Interesting that both passive and FES improved bone density. I also believe there is free full text available for those interested.


J Spinal Cord Med. 2008;31(2):215-21.

Outcomes of a home cycling program using functional electrical stimulation or passive motion for children with spinal cord injury: a case series.

Johnston TE, Smith BT, Oladeji O, Betz RR, Lauer RT.

Research Department, Shriners Hospital for Children, 3551 North Broad Street, Philadelphia, PA, USA. tjohnston@shrinenet.org

BACKGROUND/OBJECTIVE: Children with spinal cord injury (SCI) are at risk for musculoskeletal and cardiovascular complications. Stationary cycling using functional electrical stimulation (FES) or passive motion has been suggested to address these complications. The purpose of this case series is to report the outcomes of a 6-month at-home cycling program for 4 children with SCI. METHODS: Two children cycled with FES and 2 cycled passively at home for 1 hour, 3 times per week. OUTCOME MEASURES: Data collected included bone mineral density of the left femoral neck, distal femur, and proximal tibia; quadriceps and hamstring muscle volume; stimulated quadriceps and hamstring muscle strength; a fasting lipid profile; and heart rate and oxygen consumption during incremental upper extremity ergometry testing. RESULTS: The 2 children cycling with FES and 1 child cycling passively exhibited improved bone mineral density, muscle volume, stimulated quadriceps strength, and lower resting heart rate. For the second child cycling passively, few changes were realized. Overall, the lipid results were inconsistent, with some positive and some negative changes seen. CONCLUSIONS: This case series suggests that cycling with or without FES may have positive health benefits and was a practical home exercise option for these children with SCI.

http://www.ncbi.nlm.nih.gov/pubmed/18581671?ordinalpos=3&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum



J Spinal Cord Med. 2008;31(2):197-201.

Does standing protect bone density in patients with chronic spinal cord injury?

Goktepe AS, Tugcu I, Yilmaz B, Alaca R, Gunduz S.


Department of Physical Medicine and Rehabilitation, Gulhane Military Medical Academy, TSK Rehabilitasyon Merkezi Bilkent, Ankara, Turkey. asgoktepe@hotmail.com

BACKGROUND/OBJECTIVE: To compare the t-scores of proximal femur and lumbar spine of patients with spinal cord injury (SCI) with different levels of weight bearing. METHODS: Cross-sectional study comparing 3 groups of patients with SCI: patients with daily standing times of more than 1 hour, patients with daily standing times of less than 1 hour, and nonstanding patients. Seventy-one patients with chronic SCI were recruited. They were assigned to 1 of 3 groups according to their reported daily standing time. The bone density of lumbar and proximal femoral regions was measured with dual-energy x-ray absorptiometry. RESULTS: The 3 groups were similar in terms of demographics and clinical variables. No significant difference was found among the mean t-scores of lumbar and proximal femoral regions of the groups. However, the patients in the group that stood more than 1 hour daily had a slight tendency to have higher t-scores than those in the control group. CONCLUSIONS: There was no significant difference among the 3 groups. However, standing might be partially helpful in protecting the bone density in SCI by opposing the effects of immobilization.

http://www.ncbi.nlm.nih.gov/pubmed/18581668?ordinalpos=4&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum

[goat]

My 20 year old son 8 months out was recently told he has ostoepenia in the lumbar region and it has been recommended to take fosomax... Not to excited about taking another drug with all the side effects....but what is one to do ..

Med Hypotheses. 1991 Aug;35(4):316-8.
Conventional treatment with vitamin D, calcium, and estrogen will delay but not reverse osteoporosis. The addition of fluoride may increase bone mass but fails to increase bone strength; fracture incidence is actually increased in non-vertebral bone by fluoride. Clearly, successful treatment of osteoporosis remains an unsolved problem. In women, osteoporosis coincides with menopause. The hypothesis that progesterone and not estrogen is the missing factor was tested in a clinical setting and was found to be extraordinarily effective in reversing osteoporosis.

Endocrine Abstracts (2004) 7 P10
Department of Medicine, Queen Elizabeth Hospital,
University of Birmingham, Birmingham, UK.
The role of oestrogens and androgens on bone metabolism has been studied extensively. However, less is known about the effects of progestins. The progesterone receptor (PR) is expressed in human osteoblasts. Progestins have been found to stimulate osteoblast proliferation, differentiation and growth factor expression (e.g. IGFBP-5) and to increase bone formation. [...]


Transdermal progesterone is readily availabe OTC.
Organic Dulse is a great source of calcium, potassium, iodine, B12, et.al.

[Norm]

My Doctor told me to see either an endocrinologist or rheumatologist. Which Doc is better for Osteo & Spinal Cord Injury.

[antiquity]

My Doctor told me to see either an endocrinologist or rheumatologist. Which Doc is better for Osteo & Spinal Cord Injury.

I saw an orthopedist.

[c473s]

My Insurance Co. came to their senses after 3 months of waiting. They are now paying for Forteo. But only for six months. To see if it works. I started my first injection on tuesday.

Reclast is a once a year infusion that has had good results.