Low bone mineral density and fragility fractures in permanent vegetative state patients.
Disuse of the musculoskeletal system causes bone loss. Whether patients in vegetative state, a dramatic example of immobilization after severe brain injury, suffer from bone loss and fractures is currently unknown. Serum markers of bone turnover, bone mineral density (BMD) measurements, and clinical data were cross-sectionally analyzed in 30 consecutive vegetative state patients of a dedicated apallic care unit between 2003 and 2007 and compared with age- and sex-matched healthy individuals. Vegetative state patients showed low calcium levels and vitamin D deficiency compared with healthy controls. Serum bone turnover markers revealed high turnover as evidenced by markedly elevated carboxy-terminal telopeptide of type I collagen (β-crosslaps) and increased levels of alkaline phosphatase. BMD measured by dual-energy X-ray absorptiometry (DXA) scanning showed strongly decreased T- and Z-scores for hip and spine. Over a period of 5 years, 8 fragility fractures occurred at peripheral sites in 6 of 30 patients (n = 3 femur, n = 2 tibia, n = 2 fibula, n = 1 humerus). In conclusion, high bone turnover and low BMD is highly prevalent in vegetative state patients, translating into a clinically relevant problem as shown by fragility fractures in 20% of patients over a time period of 5 years. .
Ludwig Boltzmann Institute of Osteology at the Hanusch Hospital of WGKK and AUVA Trauma Centre Meidling, 1st Medical Department, Hanusch Hospital, Vienna, Austria.
Bastian
B
Oppl
Gabriele
G
Michitsch
Barbara
B
Misof
Stefan
S
Kudlacek
Johann
J
Donis
Klaus
K
Klaushofer
Jochen
J
Zwerina
Elisabeth
E
Zwettler
D015502:Absorptiometry, Photon; D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D015519:Bone Density; D002118:Calcium / Q000097:blood*; D005260:Female; D005500:Follow-Up Studies; D050723:Fractures, Bone / Q000097:blood*; D006615:Hip / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D018458:Persistent Vegetative State / Q000097:blood* / Q000473:pathology; D013131:Spine / Q000473:pathology; D014807:Vitamin D / Q000097:blood*; D014808:Vitamin D Deficiency / Q000097:blood
D015415:Biomarkers; D014807:Vitamin D; D002118:Calcium
BONE TURNOVER; IMMOBILIZATION; OSTEOPOROSIS; SCLEROSTIN; VEGETATIVE STATE