Effects of Electrical Stimulation and Vitamin D supplementation on Bone Health Following Spinal Cord Injury.

电刺激和补充维生素 D 对脊髓损伤后骨骼健康的影响。

• 批准号: 10315332
• 负责人: Dora E. Ifon
• 金额: --
• 依托单位: VA VETERANS ADMINISTRATION HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-10-01 至 2023-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10315332
• 关键词: Address; Adherence; Affect; Age-Years; Alkaline Phosphatase; Analysis of Variance; Androgens; Architecture; Attenuated; Biological Assay; Biological Markers; Blood specimen; Bone Density; Bone Resorption; Bone remodeling; Calcium; Chronic; Clinical; Collagen Type I; Complication; Consensus; Cyclophosphamide; Data; Deterioration; Disease; Distal; Dose; Dual-Energy X-Ray Absorptiometry; Economic Burden; Electric Stimulation; Enrollment; Evaluation; Exercise; Experimental Designs; Family; Fatty acid glycerol esters; Femur; Fracture; Healthcare Systems; Home; Hydroxyproline; Individual; Injury; Intervention; Intramuscular; Life; Limb structure; Link; Magnesium; Magnetic Resonance Imaging; Measurement; Measures; Medical; Medical Research; Microscopic; Motor; Movement; Muscle; N-terminal; Oral; Osteogenesis; Osteoporosis; PTH gene; Paralysed; Participant; Persons; Pharmacologic Substance; Physical activity; Pilot Projects; Process; Procollagen; Property; Protocols documentation; Quality of life; Randomized; Rehabilitation therapy; Replacement Therapy; Risk; Role; Serum; Skeletal Muscle; Spinal cord injury; Structure; Supplementation; Surface; Time; Training; Veterans; Vitamin D; Vitamin D Deficiency; Vitamin D supplementation; Work; attenuation; base; bone; bone health; bone loss; bone quality; bone turnover; comorbidity; crosslink; demineralization; experience; improved; kinematics; long bone; mechanical load; muscle hypertrophy; neuromuscular stimulation; osteoporosis with pathological fracture; post intervention; rehabilitation paradigm; strength training; substantia spongiosa; telehealth; tibia; trial design

Project Summary/Abstract Neurogenic osteoporosis is a devastating problem that is likely to impact 46,000 Veterans with chronic spinal cord injury (SCI). It is typically associated with low impact fractures of long bones and other medical comorbidities. It is estimated that approximately fifty percent of all individuals with SCI will develop low impact fracture during their lifetime. The management of osteoporosis related fractures can impose substantial economic burden on the health care system, individuals with SCI and their families. Advancement in medical research clearly indicated that neurogenic osteoporosis is linked to reduced loading and Vitamin D (Vit D) deficiency. Our pilot work indicated that a simple rehabilitation paradigm targeting towards evoking skeletal muscle hypertrophy may attenuate deterioration in trabecular bone parameters after SCI. Evoked resistance training (RT) using surface neuromuscular electrical stimulation (NMES) has been shown as a successful and feasible home-based approach to load skeletal muscles after SCI. Our earlier results may imply long term compliance and adherence if successfully applied in conjunction with a telehealth approach. In the present study, we propose a simple home-based approach of using NMES RT in conjunction with oral Vit D supplementation on trabecular bone quality in 20 Veterans with chronic SCI. Data will include measurements of trabecular bone quality as determined by magnetic resonance imaging (MRI) and bone biomarkers associated with the process of bone remodeling. Twenty participants with chronic (> 1-year post-injury) motor complete (AIS A and B) SCI (18 to 65 years of age) will be randomly assigned into either NMES RT plus 2000IU of Vit D (10 participants) or passive movement plus 2000IU Vit D (10 participants) to participate in a repeated measure design trial for 9 months. The NMES RT plus Vit D will undergo 4.5 months of open kinematic chain resistance training followed by 4.5 months of closed kinematic chain using simple rowing approach. This pilot work will have two main specific aims. Aim 1. To determine the impact of home based NMES RT protocol plus oral Vit D supplementation compared to passive movement plus oral Vit D on bone microarchitectural properties. Aim 2. To determine the impact of home based NMES RT protocol plus oral Vit D compared to passive movement and Vit D supplementation on biomarkers of bone formation and bone resorption. Key words: Spinal cord injury, osteoporosis, bone turnover, bone remodeling, bone biomarkers, electrical stimulation, vitamin D.