Acute bone changes after lower limb amputation resulting from traumatic injury

Summary Bone health is critical for lower limb amputees, affecting their ability to use a prosthesis and their risk of osteoporosis. We found large losses in hip bone mineral density (BMD) and in amputated bone strength in the first year of prosthesis use, suggesting a need for load bearing interven...

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Bibliographic Details
Published in:Osteoporosis international 2017-07, Vol.28 (7), p.2177-2186
Main Authors: Bemben, D. A., Sherk, V. D., Ertl, W. J. J., Bemben, M. G.
Format: Article
Language:English
Subjects:
Absorptiometry, Photon
Adult
Alkaline phosphatase
Amputation
Amputation - adverse effects
Artificial Limbs
Bone Density - physiology
Bone loss
Bone mineral density
Bone resorption
Bone strength
Bone surgery
Bone turnover
Cortical bone
Dual energy X-ray absorptiometry
Endocrinology
Female
Follow-Up Studies
Hip
Humans
Lower Extremity - injuries
Lower Extremity - surgery
Male
Medicine
Medicine & Public Health
Middle Aged
Original Article
Orthopedics
Osteoporosis
Osteoporosis - etiology
Osteoporosis - physiopathology
Porosity
Postoperative Period
Prostheses
Rheumatology
SOST protein
Spine
Tomography, X-Ray Computed
Walking
Young Adult
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Summary:Summary Bone health is critical for lower limb amputees, affecting their ability to use a prosthesis and their risk of osteoporosis. We found large losses in hip bone mineral density (BMD) and in amputated bone strength in the first year of prosthesis use, suggesting a need for load bearing interventions early post-amputation. Introduction Large deficits in hip areal BMD (aBMD) and residual limb volumetric BMD (vBMD) occur after lower limb amputation; however, the time course of these bone quality changes is unknown. The purpose of this study was to quantify changes in the amputated bone that occur during the early stages post-amputation. Methods Eight traumatic unilateral amputees (23–53 years) were enrolled prior to surgery. Changes in total body, hip, and spine aBMD (dual-energy X-ray absorptiometry); in vBMD, stress-strain index (SSI), and muscle cross-sectional area (MCSA) (peripheral QCT); and in bone turnover markers were assessed after amputation prior to prosthesis fitting (pre-ambulatory) and at 6 and 12 months walking with prosthesis. Results Hip aBMD of the amputated limb decreased 11–15%, which persisted through 12 months. The amputated bone had decreases ( p  480 mg/cm 3 (65% to 53%), suggesting an increase in cortical porosity after amputation. Bone alkaline phosphatase and sclerostin were elevated ( p  
ISSN:0937-941X
1433-2965
DOI:10.1007/s00198-017-4018-z