Non-pharmacological treatment and prevention of bone loss after spinal cord injury: a systematic review

F Biering-Sørensen; B Hansen; B S B Lee

doi:10.1038/sc.2008.177

Non-pharmacological treatment and prevention of bone loss after spinal cord injury: a systematic review

F Biering-Sørensen, B Hansen, B S B Lee

Publikation: Bidrag til tidsskrift › Tidsskriftartikel › Forskning › peer review

84 Citationer (Scopus)

Abstract

Udgivelsesdato: 2009-Jul

Originalsprog	Engelsk
Tidsskrift	Spinal Cord
Vol/bind	47
Udgave nummer	7
Sider (fra-til)	508-18
Antal sider	10
ISSN	1362-4393
DOI	https://doi.org/10.1038/sc.2008.177
Status	Udgivet - 2009

Bibliografisk note

Keywords: Animals; Bone Density; Databases, Bibliographic; Electric Stimulation Therapy; Humans; Osteoporosis; Physical Therapy Modalities; Randomized Controlled Trials as Topic; Spinal Cord Injuries; Ultrasonic Therapy; Weight-Bearing

Adgang til dokumentet

10.1038/sc.2008.177

Citationsformater

@article{56fdc0c068a411df928f000ea68e967b,

title = "Non-pharmacological treatment and prevention of bone loss after spinal cord injury: a systematic review",

abstract = "OBJECTIVE: Review the literature on non-pharmacological prevention and treatment of osteoporosis after spinal cord injury (SCI). METHODS: PubMed, EMBASE and the Cochrane Controlled Trials Register were searched. All identified papers were read by title, abstract and full-length article when relevant. Hand search of the articles' sources identified additional papers. For included studies, the level of evidence was determined. RESULTS: No studies conclusively showed an effective intervention. However, there are few randomized controlled trials (RCTs), and those that exist assess interventions and outcome measures that could be improved. Five studies on weight-bearing early post-injury are conflicting, but standing or walking may help retain bone mineral. In the chronic phase, there was no effect of weight bearing (12 studies). One study found that an early commencement of sports after SCI improved bone mineral, and the longer the period of athletic career, the higher the (leg) bone mineral. Early after SCI, there may be some effects of electrical stimulation (ES) (five studies). Chronic-phase ES studies vary (14 studies, including mixed periods after injury), but improvement is seen with longer period of training, or higher frequency or stimulus intensity. Improvements correspond to trabecular bone in the distal femur or proximal tibia. Impact vibration and pulsed electromagnetic fields may have some positive effects, whereas pulsed ultrasound does not. Six studies on the influence of spasticity show inconsistent results. CONCLUSIONS: Bone mineral should be measured around the knee; the length and intensity of the treatment should be sufficiently long and high, respectively, and should commence early after SCI. If bone mineral is to remain, the stimulation has to be possibly continued for long term. In addition, RCTs are necessary.",

author = "F Biering-S{\o}rensen and B Hansen and Lee, {B S B}",

note = "Keywords: Animals; Bone Density; Databases, Bibliographic; Electric Stimulation Therapy; Humans; Osteoporosis; Physical Therapy Modalities; Randomized Controlled Trials as Topic; Spinal Cord Injuries; Ultrasonic Therapy; Weight-Bearing",

year = "2009",

doi = "10.1038/sc.2008.177",

language = "English",

volume = "47",

pages = "508--18",

journal = "Spinal Cord",

issn = "1362-4393",

publisher = "nature publishing group",

number = "7",

}

TY - JOUR

T1 - Non-pharmacological treatment and prevention of bone loss after spinal cord injury: a systematic review

AU - Biering-Sørensen, F

AU - Hansen, B

AU - Lee, B S B

N1 - Keywords: Animals; Bone Density; Databases, Bibliographic; Electric Stimulation Therapy; Humans; Osteoporosis; Physical Therapy Modalities; Randomized Controlled Trials as Topic; Spinal Cord Injuries; Ultrasonic Therapy; Weight-Bearing

PY - 2009

Y1 - 2009

N2 - OBJECTIVE: Review the literature on non-pharmacological prevention and treatment of osteoporosis after spinal cord injury (SCI). METHODS: PubMed, EMBASE and the Cochrane Controlled Trials Register were searched. All identified papers were read by title, abstract and full-length article when relevant. Hand search of the articles' sources identified additional papers. For included studies, the level of evidence was determined. RESULTS: No studies conclusively showed an effective intervention. However, there are few randomized controlled trials (RCTs), and those that exist assess interventions and outcome measures that could be improved. Five studies on weight-bearing early post-injury are conflicting, but standing or walking may help retain bone mineral. In the chronic phase, there was no effect of weight bearing (12 studies). One study found that an early commencement of sports after SCI improved bone mineral, and the longer the period of athletic career, the higher the (leg) bone mineral. Early after SCI, there may be some effects of electrical stimulation (ES) (five studies). Chronic-phase ES studies vary (14 studies, including mixed periods after injury), but improvement is seen with longer period of training, or higher frequency or stimulus intensity. Improvements correspond to trabecular bone in the distal femur or proximal tibia. Impact vibration and pulsed electromagnetic fields may have some positive effects, whereas pulsed ultrasound does not. Six studies on the influence of spasticity show inconsistent results. CONCLUSIONS: Bone mineral should be measured around the knee; the length and intensity of the treatment should be sufficiently long and high, respectively, and should commence early after SCI. If bone mineral is to remain, the stimulation has to be possibly continued for long term. In addition, RCTs are necessary.

AB - OBJECTIVE: Review the literature on non-pharmacological prevention and treatment of osteoporosis after spinal cord injury (SCI). METHODS: PubMed, EMBASE and the Cochrane Controlled Trials Register were searched. All identified papers were read by title, abstract and full-length article when relevant. Hand search of the articles' sources identified additional papers. For included studies, the level of evidence was determined. RESULTS: No studies conclusively showed an effective intervention. However, there are few randomized controlled trials (RCTs), and those that exist assess interventions and outcome measures that could be improved. Five studies on weight-bearing early post-injury are conflicting, but standing or walking may help retain bone mineral. In the chronic phase, there was no effect of weight bearing (12 studies). One study found that an early commencement of sports after SCI improved bone mineral, and the longer the period of athletic career, the higher the (leg) bone mineral. Early after SCI, there may be some effects of electrical stimulation (ES) (five studies). Chronic-phase ES studies vary (14 studies, including mixed periods after injury), but improvement is seen with longer period of training, or higher frequency or stimulus intensity. Improvements correspond to trabecular bone in the distal femur or proximal tibia. Impact vibration and pulsed electromagnetic fields may have some positive effects, whereas pulsed ultrasound does not. Six studies on the influence of spasticity show inconsistent results. CONCLUSIONS: Bone mineral should be measured around the knee; the length and intensity of the treatment should be sufficiently long and high, respectively, and should commence early after SCI. If bone mineral is to remain, the stimulation has to be possibly continued for long term. In addition, RCTs are necessary.

U2 - 10.1038/sc.2008.177

DO - 10.1038/sc.2008.177

M3 - Journal article

C2 - 19172152

SN - 1362-4393

VL - 47

SP - 508

EP - 518

JO - Spinal Cord

JF - Spinal Cord

IS - 7

ER -