Abstract
Study Design:
This study is a retrospective review examining the prevalence of drugs commonly used in the management of spinal cord injury (SCI) which may influence bone health.
Objective:
The aim of our study was to examine the role commonly prescribed medications play in post-SCI bone health.
Setting:
We included all males 21 years of age and older who were evaluated over a 10-year period at an SCI-specialized center for a trauma-induced SCI.
Method:
We compared characteristics of individuals with normal bone mass to those with low bone mass according to their dual-energy X-ray absorptiometry (DXA) scan. Medication lists were reviewed for the presence of drugs considered to either positively or negatively affect bone metabolism.
Results:
Comparing individuals with normal bone mass (n = 68) to those with low bone mass (n = 211), only “Time after Injury” and “Level of Injury” were found to influence the likelihood of having low bone mass. Multivariate analysis failed to demonstrate significant associations between bone mass and the sum of drugs which either positively or negatively affect bone metabolism. When medications were reviewed individually, only bisphosphonates and anticonvulsants were found to be significantly associated with bone mass.
Conclusions:
Although 76% of our cohort was found to have low bone mass, the only major risk factors were “Time after Injury” and “Level of Injury”. Anticonvulsant use was more common in individuals with low bone mass compared to those with normal bone mass. Given the retrospective methodology of this work, our findings underline associations that warrant further investigation.
Similar content being viewed by others
Log in or create a free account to read this content
Gain free access to this article, as well as selected content from this journal and more on nature.com
or
References
Spinal Cord Injury (SCI) Facts and Figures at a Glance. https://www.nscisc.uab.edu/Public/Facts%202016.pdf/ [Accessed 19th 2017].
Varzi D, Coupaud SAD, Purcell M, Allan DB, Gregory JS, Barr RJ. Bone morphology of the femur and tibia captured by statistical shape modelling predicts rapid bone loss in acute spinal cord injury patients. Bone. 2015;81:495–501.
Szollar SM, Martin EM, Sartoris DJ, Parthemore JG, Deftos LJ. Bone mineral density and indexes of bone metabolism in spinal cord injury. Am J Phys Med Rehabil. 1998;77:28–35.
Garland D, Adkins R, Stewart CA. Five-year longitudinal bone evaluations in individuals with chronic complete spinal cord injury. J Spinal Cord Med. 2008;31:543–50.
Eser P, Frotzler A, Zehnder Y, Wick L, Knecht H, Denoth J, et al. Relationship between the duration of paralysis and bone structure: a pQCT study of spinal cord injured individuals. Bone. 2004;34:869–80.
Bauman WA, Cardozo CP. Osteoporosis in individuals with spinal cord injury. Pm&R. 2015;7:188–201.
Black DM, Cummings SR, Karpf DB, Cauley JA, Thompson DE, Nevitt MC, et al. Randomised trial of effect of alendronate on risk of fracture in women with existing vertebral fractures. Fracture Intervention Trial Research Group. Lancet. 1996;348:1535–41.
Shen C, Chen F, Zhang Y, Guo Y, Ding M. Association between use of antiepileptic drugs and fracture risk: a systematic review and meta-analysis. Bone. 2014;64:246–53.
Saunders KW, Dunn KM, Merrill JO, Sullivan M, Weisner C, Braden JB, et al. Relationship of opioid Uue and dosage levels to fractures in older chronic pain patients. J General Intern Med. 2010;25:310–5.
National Osteoporosis Foundation. Bone density exam/testing. https://www.nof.org/patients/diagnosis-information/bone-density-examtesting/ [Accessed 19th June 2017].
Troy KL, Morse LR. Measurement of bone: diagnosis of SCI-induced osteoporosis and fracture risk prediction. Top Spinal Cord Inj Rehabil. 2015;21:267–74.
deBruin ED, Frey-Rindova P, Herzog RE, Dietz V, Dambacher MA, Stüssi E. Changes of tibia bone properties after spinal cord injury: effects of early intervention. Arch Phys Med Rehabil. 1999;80:214–20.
Dudley-Javoroski S, Shields RK. Asymmetric bone adaptations to soleus mechanical loading after spinal cord injury. J Musculoskelet Neuron Interact. 2008;8:227–38.
Dudley-Javoroski S, Saha PK, Liang G, Li C, Gao Z, Shields RK. High dose compressive loads attenuate bone mneral loss in humans with spinal cord injury. Osteoporos Int. 2012;23:2335–46.
Dionyssiotis Y, Lyritis GP, Mavrogenis AF, Papagelopoulos PJ. Factors influencing bone loss in paraplegia. Hippokratia. 2011;15:544–59.
Lazo MG, Shirazi P, Sam M, Giobbie-Hurder A, Blacconiere MJ, Muppidi M. Osteoporosis and risk of fracture in men with spinal cord injury. Spinal Cord. 2001;39:208–14.
Carbone L, Chin AS, Lee TA, Burns SP, Svircev JN, Hoenig H, et al. The association of anticonvulsant use with fractures in spinal cord injury. Am J Phys Med Rehabil. 2013;92:1037-050.
Soleyman-Jahi S, Yousefian A, Maheronnaghsh R, Shokraneh F, Zadegan SA, Soltani A, et al. Evidence-based prevention and treatment of osteoporosis after spinal cord injury: a systematic review. Eur Spine J. 2018;27:1798–814.
Johnston TE, Marino RJ, Oleson CV, Schmidt-Read M, Leiby BE, Sendecki J, et al. Musculoskeletal effects of 2 functional electrical stimulation cycling paradigms conducted at different cadences for people with spinal cord injury: a pilot study. Arch Phys Med Rehabil. 2016;97:1413–22.
Tai V, Leung W, Grey A, Reid IR, Bolland MJ.Calcium intake and bone mineral density: systematic review and meta-analysis. BMJ. 2015;351:h4183
Haney EM, Chan BK, Diem SJ, Ensrud KE, Cauley JA, Barrett-Connor E, et al. Association of low bone mineral density with selective serotonin reuptake inhibitor use by older men. Arch Intern Med. 2007;167:1246–51.
Richards JB, Papaioannou A, Adachi JD, Joseph L, Whitson HE, Prior JC, et al. Effect of selective serotonin reuptake inhibitors on the risk of fracture. Arch Intern Med. 2007;167:188–94.
Shea ML, Garfield LD, Teitelbaum S, Civitelli R, Mulsant BH, Reynolds CF,III. et al. Serotonin-norepinephrine reuptake inhibitor therapy in late-life depression is associated with increased marker of bone resorption. Osteoporos Int. 2013;24:1741–9.
Wang CY, Fu SH, Wang CL, Chen PJ, Wu FL, Hsiao FY. Serotonergic antidepressant use and the risk of fracture: a population-based nested case-control study. Osteoporos Int. 2016;27:57–63.
Wu Q, Qu W, Crowell MD, Hentz JG, Frey KA. Tricyclic antidepressant use and risk of fractures: a meta-analysis of cohort and case-control studies. J Bone Miner Res. 2013;28:753–63.
Chung M, Lee J, Terasawa T, Lau J, Trikalinos TA. Vitamin D with or without calcium supplementation for prevention of cancer and fractures: an updated meta-analysis for the U.S. Preventive Services Task Force. Ann Intern Med. 2011;155:827–38.
Giannoulis MG, Martin FC, Nair KS, Umpleby AM, Sonksen P. Hormone replacement therapy and physical function in healthy oder men. Time to talk hormones? Endocr Rev. 2012;33:314–77.
Vestergaard P, Rejnmark L, Mosekilde L. Proton pump inhibitors, histamine H2 receptor antagonists, and other antacid medications and the risk of fracture. Calcif Tissue Int. 2006;79:76–83.
An T, Hao J, Sun S, Li R, Yang M, Cheng G, et al. Efficacy of statins for osteoporosis: a systematic review and meta-analysis. Osteoporos Int. 2017;28:47–57.
Gajic-Veljanoski O, Phua CW, Shah PS, Cheung AM. Effects of long-term low-molecular-weight heparin on fractures and bone density in non-pregnant adults: a systematic review with meta-analysis. J Gen Intern Med. 2016;31:947–57.
Weinstein RS. Glucocorticoid-induced osteoporosis and osteonecrosis. Endocrinol Metab Clin North Am. 2012;41:595–611.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Additional information
Publisher’s note: Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Supplementary information
Rights and permissions
About this article
Cite this article
Kokorelis, C., Gonzalez-Fernandez, M., Morgan, M. et al. Effects of drugs on bone metabolism in a cohort of individuals with traumatic spinal cord injury. Spinal Cord Ser Cases 5, 3 (2019). https://doi.org/10.1038/s41394-018-0146-8
Received:
Revised:
Accepted:
Published:
Version of record:
DOI: https://doi.org/10.1038/s41394-018-0146-8
