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: 10507762
• 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 2024-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10507762
• 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.

项目摘要/摘要 神经源性骨质疏松症是一个破坏性的问题，可能会影响46,000 慢性脊髓损伤的退伍军人（SCI）。它通常与低冲击骨折有关 长骨头和其他医疗合并症据估计，约有50％ 所有具有SCI的人都会在一生中出现低冲击骨折。管理 与骨质疏松相关的骨折可能会对医疗保健施加重大的经济负担 系统，有科幻的人及其家人。医学研究的进步 表明神经源性骨质疏松症与负荷减少和维生素D有关（VIT D） 不足。我们的飞行员工作表明，一个简单的康复范式针对 诱发的骨骼肌肥大可能会减弱小梁骨参数的恶化 科幻之后。使用表面神经肌肉电刺激的诱发抗性训练（RT） （NME）已显示为一种成功且可行的基于家庭的负载骨骼方法 科学后的肌肉。我们较早的结果可能意味着长期合规性和依从性 成功地与远程医疗方法一起应用。在本研究中，我们提出 一种简单的基于家庭的方法，即与口服vit d一起使用NMES RT 慢性科学的20名退伍军人中的小梁骨质量补充。数据将包括 通过磁共振成像（MRI）确定的小梁骨质量的测量 和骨生物标志物与骨骼重塑的过程相关。 二十名参与者患有慢性（> 1年后）电动机完成（AIS A和B）科幻 （18至65岁）将被随机分为NMES RT加2000IU的Vit D（10 参与者）或被动运动加上2000iu vit D（10名参与者）参加 重复测量设计试验9个月。 NMES RT PLUS VIT D将经历4.5个月 开放运动链阻力训练，然后进行4.5个月的封闭运动链 使用简单的划船方法。这项飞行员工作将具有两个主要的特定目标。目标1 确定基于家庭的NMES RT协议加口头vit d补充的影响 与被动运动加骨微体系特性上的口服vit d相比。目标2。 确定与被动相比 对骨形成和骨吸收生物标志物的运动和VIT D补充。 关键词：脊髓损伤，骨质疏松症，骨骼更新，骨骼重塑，骨骼生物标志物， 电刺激，维生素D。