title: The effect of low magnitude mechanical stimulation (LMMS) on bone density in patients with Rett syndrome: a pilot and feasibility study.
abstract: OBJECTIVE
  Low magnitude mechanical stimulation (LMMS) has been used successfully to promote bone formation in certain patient populations. This study evaluated the feasibility and effectiveness of LMMS on improving bone mineral density (BMD) in patients with Rett syndrome.
  
  
  METHODS
  A 12-month crossover pilot study design of 6 months of intervention with LMMS and 6 months without was studied in 14 subjects divided in two subgroups. BMD was assessed using Dual Energy X-ray Absorptiometry (DXA). The levels of 25-hydroxy vitamin D (25OHD), Parathyroid Hormone (PTH), Insulin-Like Growth Factor 1 (IGF-1), and circulating markers of bone resorption (NTx) were analyzed in blood samples. Health questionnaires and diet logs were obtained at 0, 6, and 12 months.
  
  
  RESULTS
  Of the 11 subjects who completed the protocol, 9 had an adherence of > 65% and showed an increase in spine BMD Z-scores from the intervention (Z: -2.51) compared to non-intervention period (Z: -2.27) of 0.23 SD (p=0.048). Following intervention, favorable trends were also observed for IGF-1 (p=0.06) and right distal femur BMD Z-scores (p=0.07).
  
  
  CONCLUSIONS
  These preliminary results are promising for a larger, placebo-controlled randomized study of subjects with Rett syndrome.
authors.affiliation: Katie's Clinic for Rett Syndrome, Children's Hospital & Research Center Oakland, Oakland, CA, USA Children's Hospital Oakland Research Institute, Oakland, CA, USA.
authors.forename: Sarah Y
authors.initials: SY
authors.lastname: Afzal
authors.affiliation: Children's Hospital Oakland Research Institute, Oakland, CA, USA Emory University, Atlanta, GA, USA.
authors.forename: Anna R
authors.initials: AR
authors.lastname: Wender
authors.affiliation: Katie's Clinic for Rett Syndrome, Children's Hospital & Research Center Oakland, Oakland, CA, USA.
authors.forename: Mary D
authors.initials: MD
authors.lastname: Jones
authors.affiliation: HEDCO Health Sciences Center, Children's Hospital Oakland Research Institute, Oakland, CA, USA.
authors.forename: Ellen B
authors.initials: EB
authors.lastname: Fung
authors.affiliation: Katie's Clinic for Rett Syndrome, Children's Hospital & Research Center Oakland, Oakland, CA, USA Children's Hospital Oakland Research Institute, Oakland, CA, USA Division of Pediatric and Rehabilitative Medicine, Children's Hospital & Research Center Oakland, Oakland, CA, USA.
authors.forename: Elaine L
authors.initials: EL
authors.lastname: Pico
mesh_terms: D015502:Absorptiometry, Photon; D000293:Adolescent; D015415:Biomarkers / Q000097:blood; D015519:Bone Density / Q000502:physiology*; D001862:Bone Resorption / Q000209:etiology / Q000517:prevention & control*; D002648:Child; D002675:Child, Preschool; D018592:Cross-Over Studies; D005240:Feasibility Studies; D005260:Female; D005269:Femur / Q000000981:diagnostic imaging; D006801:Humans; D007334:Insulin-Like Growth Factor I / Q000032:analysis; D008137:Longitudinal Studies; D008297:Male; D010281:Parathyroid Hormone / Q000097:blood; D010865:Pilot Projects; D015518:Rett Syndrome / Q000150:complications*; D013131:Spine / Q000000981:diagnostic imaging; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014732:Vibration; D014807:Vitamin D / Q000031:analogs & derivatives / Q000097:blood; D055815:Young Adult
chemical_list: D015415:Biomarkers; D010281:Parathyroid Hormone; D014807:Vitamin D; D007334:Insulin-Like Growth Factor I; C104450:25-hydroxyvitamin D
keywords: DXA; MECP2; Rett syndrome; Z-scores; bone mineral density; fracture; low magnitude mechanical stimulation (LMMS); osteopenia