Abstract
Study design:
Prospective repeated-measures longitudinal study.
Objectives:
To determine if an 8-week course of an oral anabolic steroid can positively effect body composition or pulmonary function in healthy individuals with chronic tetraplegia.
Setting:
United States.
Methods:
Oxandrolone (20 mg per day) was administered for 8 weeks to 10 men with motor complete tetraplegia. Dual X-ray absorptiometry scans, pulmonary function tests (PFTs), serum lipids and liver function tests (LFTs) were obtained at baseline, 4, 8, 12 and 20 weeks. To analyze change over time, a repeated measures General Linear Model and nonparametric tests were utilized.
Results:
Following treatment, total lean body mass (LBM) increased 1.9% and LBM of the arms increased 5.4%. Total body fat decreased 1.5%, and increased 3.9% in the arms and, on average, combined measures of PFTs improved 2.2%. High-density lipoprotein cholesterol decreased 31.8%, low density lipoprotein cholesterol increased 41.2%, and LFTs increased 9.7–65.6% while on therapy but all trended to baseline at 20 weeks.
Conclusion:
Baseline body composition was characterized by a high proportion of fat and a body mass index that underestimated chronic disease risk. Treatment with oxandrolone was associated with modest improvements in PFTs and in arm and total body LBM. Unfavorable changes in serum lipids and LFTs indicate that reported benefits of using oxandrolone in this population must be carefully weighed against potential adverse effects.
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References
Guttman L . Spinal Cord Injuries: Comprehensive Management and Research, 2nd edn. Blackwell Scientific Publications: London, 1976.
Castro MJ, Apple Jr DF, Staron RS, Campos GE, Dudley GA . Influence of complete spinal cord injury on skeletal muscle within 6 mo of injury. J Appl Physiol 1999; 86: 350–358.
Wilmet E, Ismail AA, Heilporn A, Welraeds D, Bergmann P . Longitudinal study of the bone mineral content and of soft tissue composition after spinal cord section. Paraplegia 1995; 33: 674–677.
Cardus D, McTAggart WG . Body composition in spinal cord injury. Arch Phys Med Rehabil 1985; 66: 257–259.
Spungen AM, Adkins RH, Stewart CA . Factors influencing body composition in persons with spinal cord injury: a cross-sectional study. J Appl Physiol 2003; 95: 2398–2407.
Linn WS, Spungen AM, Gong Jr H, Adkins RH, Bauman WA, Waters RL . Forced vital capacity in two large outpatient populations with chronic spinal cord injury. Spinal Cord 2001; 39: 263–268.
Baydur A, Adkins RH, Milic-Emili J . Lung mechanics in individuals with spinal cord injury: effects of injury level and posture. J Appl Physiol 2001; 90: 405–411.
Frankel HL, Coll JR, Charlifue SW, Whiteneck GG, Gardner BP, Jamous MA et al. Long-term survival in spinal cord injury: a fifty year investigation. Spinal Cord 1998; 36: 266–274.
McKinley WO, Jackson AB, Cardenas DD, DeVivo MJ . Long-term medical complications after traumatic spinal cord injury: a regional model systems analysis. Arch Phys Med Rehabil 1999; 80: 1402–1410.
Abrams D . Use of androgens in patients who have HIV/AIDS: what we know about the effect of androgens on wasting and lipodystrophy. AIDS Read 2001; 11: 149–156.
Jeschke MG, Finnerty CC, Suman OE, Kulp G, Mlcak RP, Herndon DN . The effect of oxandrolone on the endocrinologic, inflammatory, and hypermetabolic responses during the acute phase postburn. Ann Surg 2007; 246: 351–360.
Sharma S, Arneja A, McLean L, Duerksen D, Leslie W, Sciberras D et al. Anabolic steroids in COPD: a review and preliminary results of a randomized trial. Chron Respir Dis 2008; 5: 169–176.
Spungen AM, Koehler KM, Modeste-Duncan R, Rasul M, Cytryn AS, Bauman WA . 9 clinical cases of nonhealing pressure ulcers in patients with spinal cord injury treated with an anabolic agent: a therapeutic trial. Adv Skin Wound Care 2001; 14: 139–144.
Spungen AM, Grimm DR, Strakhan M, Pizzicato PM, Bauman WA . Treatment with an anabolic agent is associated with improvement in respiratory function in persons with tetraplegia: a pilot study. Mt Sinai J Med 1999; 66: 201–205.
American Spinal Injury Association. International Standards for Neurological Classification of Spinal Cord Injury, Revised 2002. American Spinal Injury Association: Atlanta, 2002.
National Heart, Lung, and Blood Institute. Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults. National Institutes for Health: Bethesda, MD, 1998. NIH publication No. 98-4083.
American Thoracic Society. Standardization of spirometry: 1994 update. Am J Respir Crit Care Med 1995; 152: 1107–1136.
Pithon KR, Martins LEB, Renno ACM, Abreu DC, Cliquet Jr A . Pulmonary function testing in quadriplegic subjects. Spinal Cord 2008; 46: 275–277.
Gater DR . Obesity after spinal cord injury. Phys Med Rehabil Clin N Am 2007; 18: 333–351.
Rajan S, McNeely MJ, Warms C, Goldstein B . Clinical assessment and management of obesity in individuals with spinal cord injury. J Spinal Cord Med 2008; 31: 361–372.
Jones LM, Legge M, Goulding A . Healthy body mass index values often underestimate body fat in men with spinal cord injury. Arch Phys Med Rehabil 2003; 84: 1068–1071.
Buchholz AC, McGillivrary CF, Pencharz PB . Differences in resting metabolic rate between paraplegic able-bodied subjects are explained by differences in body composition. Am J Clin Nutr 2003; 77: 371–378.
Gater D, Clasey J . Body composition assessment in spinal cord injury clinical trials. Top Spinal Cord Inj Rehabil 2006; 11: 36–49.
Olda E . The metabolic syndrome as a concept of adipose tissue disease. Hypertens Res 2008; 31: 1283–1291. Review.
Holt RI . International Diabetes Federation re-defines the metabolic syndrome. Diabetes Obes Metab 2005; 7: 618–620.
Acknowledgements
We are grateful to Margot Giannetti and Miriam I Spungen for their assistance in the preparation of the article. This project was funded, in part, by a grant from the Department of Defense Award No. DAMP-17-02-2-0032.
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Presented at the 34th Annual Meeting of the American Spinal Injury Association, San Diego, CA, USA
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Halstead, L., Groah, S., Libin, A. et al. The effects of an anabolic agent on body composition and pulmonary function in tetraplegia: a pilot study. Spinal Cord 48, 55–59 (2010). https://doi.org/10.1038/sc.2009.82
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DOI: https://doi.org/10.1038/sc.2009.82
