Abstract
Immobilisation or disuse is a condition known to be associated with a decrease in bone mass, osteopenia and in some people leading to osteoporosis with an increased risk of fractures. In this condition, previous histomorphometric and biochemical reports have shown an uncoupling between bone formation and resorption, but the exact sequence of the events resulting in bone loss is still not fully understood. In spinal cord injury for instance, the main finding soon after the onset is decreased osteoblastic activity associated with a dramatic increase in bone degradation. The overall consequence of these metabolic events is the development of a rapid and severe osteoporosis only observed in the paralysed part of the body associated with the loss of biomechanical strength and the biosynthesis of a structurally modified matrix which is unable to sustain normal mechanical stress. This situation dramatically increases the risk of fractures. The same uncoupling phenomenon has been described in healthy individuals who have been submitted to long duration bedrest and also in astronauts during spaceflight; but the timing, intensity and the metabolic subset may be different as these people do recover after cessation of the disuse period, which does not occur in paralysed patients. As new accurate and sensitive non-invasive techniques have become available recently to assess bone and connective tissue metabolism, more information is now available regarding bone loss in paralysed and/or immobilised individuals. These techniques should be definitely helpful in orientating new therapeutic trials with drugs and/or procedures intended to correct the musculoskeletal deleterious effects of disuse. This paper is therefore aimed at a review of bone metabolism in those with a severe spinal cord injury, or with a long duration of bedrest, or with loss of biomechanical function, or with actual or simulated spaceflight, in all instances using non-invasive techniques.
Similar content being viewed by others
Article PDF
References
Minaire P et al. Quantitative histological data on disuse osteoporosis: comparison with biological data. Calcif Tissue Res 1974; 17: 57–73.
Minaire P et al. Marrow changes in paraplegic patients. Calcif Tissue Int 1984; 36: 338–340.
Biering-Sorensen F, Bohr H H, Schaadt O P . Longitudinal study of bone mineral content in the lumbar spine, the forearm and the lower extremities after spinal cord injury. Europ J Clin Invest 1991; 20: 330–335.
Finsen V, Indredavik B, Fougner K J . Bone mineral and hormone status in paraplegics. Paraplegia 1992; 30: 343–347.
Kiratli B J . Skeletal adaptation to disuse: longitudinal and cross-sectional study of the response of the femur and spine to immobilisation (paralysis). PhD thesis. The University of Wisconsin-Madison, 1989.
Geusens P . Bone loss in the radius, lumbar spine, femoral neck and total body after paraplegia in men. J Bone Min Res 1992; 7: S-326.
Bergmann P et al. La Démineralisation osseuse chez le para-plégique. Réadaptation ¡Rev alidade 1991; 1-2: 122–127.
Garland D E et al. Osteoporosis after spinal cord injury. J Orthop Res 1992; 10: 371–378.
Bergmann P et al. Longitudinal study of calcium and bone metabolism in paraplegic patients. Paraplegia 1977-1978; 15: 147–159.
Griffiths H J, Bushueff B, Zimmerman R E . Investigation of the loss of bone mineral in patients with spinal cord injury. Paraplegia 1976; 14: 207–212.
Claus-Walker J et al. Hypercalcemia and early traumatic quadriplegia. J Chron Dis 1975; 28: 81–90.
Naftchi N E et al. Mineral metabolism in spinal cord injury. Arch Phys Med Rehabil 1980; 61: 139–142.
Chantraine A . Clinical investigation of bone metabolism in spinal cord lesions. Paraplegia 1971; 8: 253–269.
Pietschmann P et al. Increased serum osteocalcin levels in patients with paraplegia. Paraplegia 1992; 30: 204–209.
Zanone X, Castanier M, Chantraine A . Dosage de l'ostéo-calcine chez les blessés médullaires: Etude préliminaire. Ré-adaptation/Rev alidade 1991; 1-2: 89–93.
Uebelhart D et al. Early modifications of biochemical markers of bone metabolism in spinal cord injury patients: a preliminary study. Scand. J Rehab Med 1994; 26: 197–202.
Wakley G K, Portwood J S, Turner R T . Disuse osteopenia is accompanied by downregulation of gene expression for bone proteins in growing rats. Am J Physiol 1992; 263: E1029–E1034.
Globus R K, Bikle D D, Morey-Holton E . The temporal response of bone to unloading. Endocrinology 1986; 118: 733–742.
Halloran B P et al. The role of 1,25-dihydroxyvitamin D in the inhibition of bone formation induced by skeletal unloading. Endocrinology 1986; 118: 948–954.
Bikle D D et al. Skeletal unloading induces resistance to IGF-1. J Bone Min Res 1993; 8: S-155.
Genty C et al. Bone formation response to 7-day tail-suspension in rat: in vitro and in vivo studies. J Bone Min Res 1992; 7: S-217.
Grynpas M D, Patterson-Allen P, Simmons D J . The changes in quality of mandibular bone mineral in otherwise totally immobilized Rhesus monkeys. Calcif Tissue Int 1986; 39: 57–62.
Vico L, Alexandre C . Microgravity and bone adaptation at the tissue level. J Bone Min Res 1992; 7: S-445–S-447.
Backup P et al. Spaceflight results in decreased gene expression for osteocalcin in bone and actin in muscle. J Bone Min Res 1992; 7: S-122.
Schneider V et al. J Bone Min Res 1992; 7: S-122.
Bronner F et al. Quantitation of calcium metabolism in postmenopausal osteoporosis and in scoliosis. J Clin Invest 1963; 42: 898.
Jaworski Z F G, Uhthoff H K . Reversibility of nontraumatic disuse osteoporosis during its active phase. Bone 1986; 7: 431–439.
Thompson D D, Rodan G A . Indomethacin inhibition of teno-tomy-induced bone resorption in rats. J Bone Min Res 1988; 3: 409–414.
Howard W H, Parcher J W, Young D R . Primate restraint system for studies of metabolic responses during recumbency. Lab Animal Science 1971; 21: 112–1172.
Young D R et al. Immobilisation-associated osteoporosis in primates. Bone 1986; 7: 109–117.
Mechanic G L et al Nonmineralized and mineralized bone collagen in bone of immobilized monkeys. Calcif Tissue Int 1986; 39: 63–68.
Schneider V S, McDonald J . Skeletal calcium homeostasis and counter measures to prevent disuse osteoporosis. Calcif Tissue Int 1984; 36: S-151–S-154.
LeBlanc A et al. Spinal bone mineral after 5 weeks of bed rest. Calcif Tissue Int 1987; 41: 259–261.
LeBlanc A D et al. Bone mineral loss and recovery after 17 weeks of bed rest. J Bone Min Res 1990; 5: 843–850.
Grigoriev A I et al. Effect of exercise and bisphosphonate on mineral balance and bone density during 360 day antiorthostatic hypokinesia. J Bone Min Res 1992; 7: S-449–S-445.
Van der Wiel H E et al. Biochemical parameters of bone turnover during ten days of bed rest and subsequent mobilization. Bone Mineral 1991; 13: 123–129.
Pedersen B J et al. Bed rest and osteoporosis alters the circadian rythm of type I collagen synthesis. J Bone Min Res 1993; 8: S-324.
Keene D R, Sakai L Y, Burgeson R E . Human Bone contains type II collagen, type VI collagen and fibrillin. J Histochem Cytochem 1991; 39: 59–69.
Rucklidge G J et al. Turnover rates of different collagen types measured by isotope ratio mass spectrometry. Biochim Biophys Acta 1992; 1156: 57–61.
Bailey A J et al. Biochemical changes in the collagen of human osteoporotic bone matrix. Connective Tissue Res 1993; 29: 119–132.
Batge B et al. Compositional analysis of the collagenous bone matrix: a study on adult normal and oteopenic bone tissue. Eur J Clin Invest 1992; 22: 805–812.
Notbohm H et al. Comparitive study on the thermostability of collagen I of skin and bone: influence of posttranslational hydroxylation of prolyl and lysyl residues. J Prot Chem 1992; 11: 635–643.
Author information
Authors and Affiliations
Additional information
This paper is dedicated to the memory of Pierre Minaire
Rights and permissions
About this article
Cite this article
Uebelhart, D., Demiaux-Domenech, B., Roth, M. et al. Bone metabolism in spinal cord injured individuals and in others who have prolonged immobilisation. A review. Spinal Cord 33, 669–673 (1995). https://doi.org/10.1038/sc.1995.140
Issue Date:
DOI: https://doi.org/10.1038/sc.1995.140
Keywords
This article is cited by
-
Team IHMC at the 2020 Cybathlon: a user-centered approach towards personal mobility exoskeletons
Journal of NeuroEngineering and Rehabilitation (2022)
-
Evidence-based prevention and treatment of osteoporosis after spinal cord injury: a systematic review
European Spine Journal (2018)
-
Impact on bone and muscle area after spinal cord injury
BoneKEy Reports (2015)
-
Bone marrow changes related to disuse
European Radiology (2013)
-
Steady and Oscillatory Fluid Flows Produce a Similar Osteogenic Phenotype
Calcified Tissue International (2011)