title: Accelerated bone turnover identifies hemiplegic patients at higher risk of demineralization.
abstract: Immobilization osteoporosis represents a severe complication in hemiplegic patients (HPs), causing fragility fractures, which may occur during rehabilitation reducing functional recovery and survival. The aim of the study was to investigate determinants of bone loss, independent from length of immobilization, which may be useful in early identification of HPs at higher risk of demineralization. Forty-eight HPs of both sexes underwent anthropometric measurements, evaluation of scores of spasticity and of lower limb motory capacity. Laboratory tests were performed. On serum: calcium; phosphorus; creatinine; ALP; iPTH; 25(OH) vitamin-D; sex hormones; Δ4-androstenedione; DHEA-S; insulin; IGF-1; FT3; FT4; TSH; c-AMP. On urine: c-AMP and calcium/creatinine ratio. Two bone turnover markers were measured: serum osteocalcin (BGP) and urinary deoxypyridinoline (DPD). Bone mineral density was determined at both femoral necks, defining a percentage difference in bone loss between paretic and non-paretic limb, thus controlling for the complex cofactors involved. Only bone turnover markers significantly and directly correlated with the entity of demineralization, controlling for age, sex and length of immobilization in the multivariate analysis (BGP coefficient estimate=0.008; SE=0.003; p=0.020; DPD coefficient estimate=0.005; SE=0.002; p=0.036). BGP and DPD are not dependent on anthropometric and endocrine-metabolic parameters, disability patterns and duration of immobilization, thus represent independent determinants of the degree of demineralization. A cutoff was defined for BGP and DPD above which subjects show significantly greater risk of demineralization. The immobilization event generates more severe bone loss when it occurs in subjects with higher bone turnover. BGP and DPD measurements may be of primary importance for early identification of HPs at risk, with relevant preventive implications.
authors.affiliation: Rehabilitation Unit, University Federico II, Naples, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Del Puente
authors.affiliation: Rheumatologic Rehabilitation Unit, S. Maugeri Foundation, IRCCS, Telese Terme, Italy; Rehabilitation Unit, S. Maugeri Foundation, IRCCS, Cassano delle Murge, Italy.
authors.forename: N
authors.initials: N
authors.lastname: Pappone
authors.affiliation: Rehabilitation Unit, University Federico II, Naples, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Servodio Iammarrone
authors.affiliation: Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Esposito
authors.affiliation: Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Scarpa
authors.affiliation: Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy; Rheumatology Unit, Department of Medicine DIMED, University.
authors.forename: L
authors.initials: L
authors.lastname: Costa
authors.affiliation: Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy; Rheumatology Unit, Department of Medicine DIMED, University.
authors.forename: F
authors.initials: F
authors.lastname: Caso
authors.affiliation: Rehabilitation Unit, S. Maugeri Foundation, IRCCS, Cassano delle Murge, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Bardoscia
authors.affiliation: Rheumatology Unit, Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Del Puente
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018488:Bone Demineralization, Pathologic / Q000150:complications* / Q000503:physiopathology*; D016723:Bone Remodeling; D005260:Female; D006429:Hemiplegia / Q000150:complications* / Q000503:physiopathology*; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D012307:Risk Factors