| 소속 |
TBI rehabilitation center, National Traffic Injury Rehabilitation Hospital, TBI rehabilitation center1, Department of Rehabilitation Medicine, Seoul National University Hospital, Department of Rehabilitation Medicine2, Graduate School of Yonsei University, Department of Medicine3, Seoul National University Hospital Biomedical Research Institute, Department of Rehabilitation Medicine4 |
Background : Low bone mineral density (BMD) leads to an increased risk of fracture. Patients who have sustained a significant traumatic brain injury (TBI) may have an increased risk of secondary reduced BMD as a result of immobility and other factors. Little is known, however, about the BMD of patients with TBI. It is only in recent years that there is growing awareness that hormonal signals and neural circuits that originate in the hypothalamus play key roles in regulating skeletal system based on recent mouse genetic studies. Accordingly, many TBI patients have also presented with hormonal dysfunction, increased skeletal fragility, and increased risk of skeletal diseases. In this study, we aimed to investigate the consequence of TBI in BMD and elucidate the relationships between clinical parameters and BMD.
Methods : The study was a retrospective, cross sectional study of male patients after TBI who were admitted to a comprehensive neurorehabilitation hospital in the Republic of Korea over a 4 year period from May, 2016,
to July, 2020. To eliminate postmenopausal osteoporosis, 37 male TBI patients were included. T scores and absolute BMD (g/cm 2 ) in the lumbar spine, bilateral femur, disability variables (e.g. motor power, spasticity, balance, gait, and cognitive function), serum vitamin levels, and endocrine profile were retrospectively analyzed.
Results : Participants had suboptimal BMD measurements that were generally low for their age and gender. Fifteen (40.54%) and four (10.81%) participants met the criteria for osteopenia and osteoporosis, respectively. BMI was significantly associated with BMD of lumbar spine (P<.05). Total MMT of bilateral lower limbs, K-MBI, and BBS scores demonstrated significant correlation to BMD of less paretic hip (p<0.05). Serum osmolality level was significantly associated with BMD of lumbar spine and hip (p<0.05). Serum vitamin B1 and insulin-like growth factor 1 (IGF-1) levels were significantly related to BMD of lumbar spine (p<0.05).
Conclusion : Patients who have experienced TBI may have an increased risk of osteopenia and osteoporosis, which are asymptomatic systemic skeletal diseases result in the micro-architectural deterioration of bone tissue leading to bone fragility and ultimately, fractures. TBI-induced skeletal changes seems to be correlated with functional parameters such as motor power of lower extremities and balance function and dependent in part on the variations in IGF-1, and serum vitamin B1 and osmolality levels. This study showed that early BMD screening and monitoring is critical during the inpatient rehabilitation in male TBI patients to prevent further bone loss and associated complications. Further investigation on skeletal effect of immobility and neural damage after TBI is necessary to establish the optimal osteoporosis rehabilitation program for TBI survivors. |
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Table 1. Baseline demographics and clinical parameters of male patients with traumatic brain injury
Comparison of T-scores and absolute BMD (g/cm2) in the lumbar spine, affected, and unaffected limbs between two groups
Correlation between T-scores and clinical parameters in Low Bone Density or Osteoporosis groups
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