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Effects of drugs on bone metabolism in a cohort of individuals with traumatic spinal cord injury.

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.

SUBMITTER: Kokorelis C

PROVIDER: S-EPMC6335409 | biostudies-literature | 2019

REPOSITORIES: biostudies-literature

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Effects of drugs on bone metabolism in a cohort of individuals with traumatic spinal cord injury.

Kokorelis Christina C Gonzalez-Fernandez Marlis M Morgan Marjorie M Sadowsky Cristina C

Spinal cord series and cases 20190116

<h4>Study design</h4>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.<h4>Objective</h4>The aim of our study was to examine the role commonly prescribed medications play in post-SCI bone health.<h4>Setting</h4>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.<h4>Method</h4>We compared charac ...[more]

PMID: 30675387

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Project description:BackgroundTraumatic spinal cord injury (SCI) is a major clinical concern, and it is a life-changing neurological condition with substantial socioeconomic implications. Muscone has been widely used in traditional Chinese medicinal formulations for its anti-inflammatory activity. However, its protective effects on traumatic SCI have not been explored. This study investigated whether muscone plays a protective role in SCI and compared its effects with those of methylprednisolone sodium succinate (MPSS).MethodsRats were divided into five groups: normal saline (NS; n=24), methylprednisolone (MP; w=24), and muscone 1 (MO1), muscone 2 (MO2), and muscone 3 (MO3) (n=24 in each group, collectively called the MOx groups). The SCI rat model was established by the modified Allen's method. The rats were administered muscone (MO1: 2.5 mg/kg, MO2: 5 mg/kg, and MO3: 10 mg/kg) or MP (30 mg/kg), or an equivalent volume of saline. The rats were kept under observation for 4 weeks. Malondialdehyde (MDA), superoxide dismutase (SOD), interleukin-6 (IL-6), interleukin-1β (IL-1β), and tumor necrosis factor-alpha (TNF-α) levels were detected using enzyme-linked immunosorbent assay (ELISA). The expression of glial fibrillary acidic protein (GFAP), B-cell lymphoma-2 (BCL-2), and caspase3 was detected by western blot analysis. Hematoxylin-eosin (HE), Nissl, and immunocytochemistry (ICC) staining was performed for pathological observation. Basso-Beattie-Bresnahan motor function scores were evaluated for assessment of neural functions after acute SCI.ResultsMuscone inhibited immune-inflammatory reactions, neuronal necrosis, and apoptosis. The lower limb function recovery was better in the MOx groups compared with NS and MP groups according to Basso-Beattie-Bresnahan scores. The changes were remarkable in the MO2 group compared with the other groups.ConclusionsMuscone alleviates secondary injury after SCI by reducing immune-inflammatory reactions, neuronal necrosis, and apoptosis.

Project description:BackgroundNeurogenic bladder dysfunction represents one of the most common and devastating sequelae of traumatic spinal cord injury (SCI). As early prediction of bladder outcomes is essential to counsel patients and to plan neurourological management, we aimed to develop and validate a model to predict urinary continence and complete bladder emptying 1 y after traumatic SCI.Methods and findingsUsing multivariate logistic regression analysis from the data of 1,250 patients with traumatic SCI included in the European Multicenter Spinal Cord Injury study, we developed two prediction models of urinary continence and complete bladder emptying 1 y after traumatic SCI and performed an external validation in 111 patients. As predictors, we evaluated age, gender, and all variables of the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) and of the Spinal Cord Independence Measure (SCIM). Urinary continence and complete bladder emptying 1 y after SCI were assessed through item 6 of SCIM. The full model relies on lower extremity motor score (LEMS), light-touch sensation in the S3 dermatome of ISNCSI, and SCIM subscale respiration and sphincter management: the area under the receiver operating characteristics curve (aROC) was 0.936 (95% confidence interval [CI]: 0.922-0.951). The simplified model is based on LEMS only: the aROC was 0.912 (95% CI: 0.895-0.930). External validation of the full and simplified models confirmed the excellent predictive power: the aROCs were 0.965 (95% CI: 0.934-0.996) and 0.972 (95% CI 0.943-0.999), respectively. This study is limited by the substantial number of patients with a missing 1-y outcome and by differences between derivation and validation cohort.ConclusionsOur study provides two simple and reliable models to predict urinary continence and complete bladder emptying 1 y after traumatic SCI. Early prediction of bladder function might optimize counselling and patient-tailored rehabilitative interventions and improve patient stratification in future clinical trials.

Dataset Information

Effects of drugs on bone metabolism in a cohort of individuals with traumatic spinal cord injury.

Publications

Effects of drugs on bone metabolism in a cohort of individuals with traumatic spinal cord injury.

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