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

项目摘要/摘要 神经性骨质疏松症是一个毁灭性的问题，可能会影响46,000人 患有慢性脊髓损伤(SCI)的老兵。它通常与低冲击性骨折有关。 长骨和其他医学合并症。据估计，大约50%的 所有患有脊髓损伤的人在他们的一生中都会发展成低冲击性骨折。企业的管理 与骨质疏松相关的骨折会给医疗保健带来巨大的经济负担 系统、脊髓损伤患者及其家人。明确医学研究的进展 神经性骨质疏松症与负荷减少和维生素D(VitD)有关 缺乏症。我们的试点工作表明，一个简单的康复范例旨在 诱发骨骼肌肥大可以减轻骨小梁参数的恶化 在SCI之后。体表神经肌肉电刺激诱发阻力训练(RT) (NMES)已被证明是一种成功和可行的基于家庭的骨骼加载方法 脊髓损伤后的肌肉。我们早期的结果可能意味着长期的合规和遵守，如果 成功地与远程保健方法结合使用。在本研究中，我们建议 NMES RT联合口服维生素D的简易家庭治疗方法 补充骨小梁对20例慢性脊髓损伤退伍军人骨量的影响数据将包括 磁共振成像(MRI)测定骨小梁质量 以及与骨重建过程相关的骨生物标志物。 20名慢性(伤后1年)运动完全性(AIS A和B)SCI的参与者 (18至65岁)将被随机分配到NMES RT加2000IU维生素D(10 参与者)或被动运动加2000IU维生素D(10名参与者)参加 重复测量设计试验9个月。NMES RT加维生素D将经历4.5个月 开放式运动链阻力训练，然后是4.5个月的闭合运动链 使用简单的划船方法。这项试点工作将有两个主要的具体目标。目标1.目标 确定基于家庭的NMES RT方案和口服维生素D补充剂的影响 比较被动运动加口服维生素D对骨微结构特性的影响。目标2. 确定基于家庭的NMES RT方案加口服维生素D与被动方案的影响 运动和补充维生素D对骨形成和骨吸收生物标志物的影响。 关键词：脊髓损伤，骨质疏松，骨转换，骨重建，骨生物标志物 电刺激，维生素D。

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.