Low magnitude mechanical loading is osteogenic in children with disabling conditions
Low magnitude mechanical loading is osteogenic in children with disabling conditions
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DOI：
10.1359/jbmr.040129
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发表时间：
2004-03-01
影响因子：
6.2
通讯作者：
Mughal, Z
中科院分区：
文献类型：
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作者：
Ward, K;Alsop, C;Mughal, Z
在残疾儿童中研究了短时间低水平机械刺激的成骨潜力。干预组胫骨vTBMD的平均变化为+6.3%，而对照组为-11.9%。这个试点随机对照试验提供了初步证据表明，低水平的机械刺激是一种非侵入性的，非药物治疗的低BMD的儿童致残conditions.Introduction：最近的动物研究已经证明了合成代谢潜力的低幅度，高频率的机械刺激的骨小梁的承重区域的骨骼。这项前瞻性、双盲、随机、安慰剂对照的先导性试验（RCT）的主要目的是检查这些信号是否能有效增加胫骨和脊柱体积骨小梁BMD材料和方法：20名青春期前或青春期后残疾的非卧床儿童，（14名男性，6名女性;平均年龄，9.1 ± 4.3岁;范围，4-19岁）被随机分配到主动（n = 10; 0.3g，90 Hz）或安慰剂（n = 10）装置上站立10分钟/天，5天/周，持续6个月。试验的主要结局是使用3-D QCT测量的胫骨近端和脊柱（L-2）vTBMD（mg/ml）。事后分析，以确定治疗是否有骨干皮质骨和肌肉parameters.Results和结论的影响：依从性为44%（4.4分钟，每天），确定平均治疗时间（567.9分钟）相比，预期的治疗时间超过6个月（1300分钟）。6个月后，使用有源器械的儿童胫骨近端vTBMD的平均变化为6.27 mg/ml（+6.3%）;使用安慰剂器械的儿童胫骨近端vTBMD降低了-9.45 mg/ml（-11.9%）。因此，治疗的净获益为+ 15.72 mg/ml（17.7%; p = 0.0033）。在脊柱中，与安慰剂相比，治疗的净获益为+6.72 mg/ml（p = 0.14）。骨干骨和肌肉参数未显示对治疗的反应。这项试验性随机对照试验的结果首次表明，低幅度、高频率的机械刺激对儿童的骨小梁具有合成代谢作用，这可能是通过为残疾人的肌肉活动抑制提供替代品。在较长的治疗期间，利用骨骼对这些刺激的敏感性可以为儿童的骨脆性提供非药物治疗。
The osteogenic potential of short durations of low-level mechanical stimuli was examined in children with disabling conditions. The mean change in tibia vTBMD was +6.3% in the intervention group compared with -11.9% in the control group. This pilot randomized controlled trial provides preliminary evidence that low-level mechanical stimuli represent a noninvasive, non-pharmacological treatment of low BMD in children with disabling conditions.Introduction: Recent animal studies have demonstrated the anabolic potential of low-magnitude, high-frequency mechanical stimuli to the trabecular bone of weight-bearing regions of the skeleton. The main aim of this prospective, double-blind, randomized placebo-controlled pilot trial (RCT) was to examine whether these signals could effectively increase tibial and spinal volumetric trabecular BMD (vTBMD; mg/ml) in children with disabling conditions.Materials and Methods: Twenty pre-or postpubertal disabled, ambulant, children (14 males, 6 females; mean age, 9.1 +/- 4.3 years; range,4-19 years) were randomized to standing on active (n = 10; 0.3g, 90 Hz) or placebo (n = 10) devices for 10 minutes/day, 5 days/week for 6 months. The primary outcomes of the trial were proximal tibial and spinal (L-2) vTBMD (mg/ml), measured using 3-D QCT. Posthoc analyses were performed to determine whether the treatment had an effect on diaphyseal cortical bone and muscle parameters.Results and Conclusions: Compliance was 44% (4.4 minutes per day), as determined by mean time on treatment (567.9 minutes) compared with expected time on treatment over the 6 months (1300 minutes). After 6 months, the mean change in proximal tibial vTBMD in children who stood on active devices was 6.27 mg/ml (+6.3%); in children who stood on placebo devices, vTBMD decreased by -9.45 mg/ml (-11.9%). Thus, the net benefit of treatment was + 15.72 mg/ml (17.7%; p = 0.0033). In the spine, the net benefit of treatment, compared with placebo, was +6.72 mg/ml, (p = 0.14). Diaphyseal bone and muscle parameters did not show a response to treatment. The results of this pilot RCT have shown for the first time that low-magnitude, high-frequency mechanical stimuli are anabolic to trabecular bone in children, possibly by providing a surrogate for suppressed muscular activity in the disabled. Over the course of a longer treatment period, harnessing bone's sensitivity to these stimuli may provide a non-pharmacological treatment for bone fragility in children.