Disrupted Bone Metabolism in Long-Term Bedridden Patients.
BACKGROUND
Bedridden patients are at risk of osteoporosis and fractures, although the long-term bone metabolic processes in these patients are poorly understood. Therefore, we aimed to determine how long-term bed confinement affects bone metabolism.


METHODS
This study included 36 patients who had been bedridden from birth due to severe immobility. Bone mineral density and bone metabolism markers were compared to the bedridden period in all study patients. Changes in the bone metabolism markers during a follow-up of 12 years were studied in 17 patients aged <30 years at baseline.


RESULTS
The bone mineral density was reduced (0.58±0.19 g/cm3), and the osteocalcin (13.9±12.4 ng/mL) and urine N-terminal telopeptide (NTX) levels (146.9±134.0 mM BCE/mM creatinine) were greater than the cutoff value for predicting fracture. Among the bone metabolism markers studied, osteocalcin and NTX were negatively associated with the bedridden period. During the follow-up, osteocalcin and parathyroid hormone were decreased, and the 25(OH) vitamin D was increased. NTX at baseline was negatively associated with bone mineral density after 12 years.


CONCLUSIONS
Unique bone metabolic abnormalities were found in patients who had been bedridden for long periods, and these metabolic abnormalities were altered by further bed confinement. Appropriate treatment based on the unique bone metabolic changes may be important in long-term bedridden patients.
Divisions of Pediatric Orthopedic Surgery, Nishi-Niigata Chuo National Hospital, Niigata, Japan.|Department of Regenerative and Transplant Medicine, Division of Orthopedic Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
Keiko
http://orcid.org/0000-0003-3484-9195
K
Eimori
Department of Regenerative and Transplant Medicine, Division of Orthopedic Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
Naoto
N
Endo
Divisions of Orthopedic Surgery, Nishi-Niigata Chuo National Hospital, Niigata, Japan.
Seiji
S
Uchiyama
Divisions of Orthopedic Surgery, Nishi-Niigata Chuo National Hospital, Niigata, Japan.
Yoshinori
Y
Takahashi
Department of Regenerative and Transplant Medicine, Division of Orthopedic Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
Hiroyuki
H
Kawashima
Department of Regenerative and Transplant Medicine, Division of Orthopedic Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
Kei
K
Watanabe
D015652:25-Hydroxyvitamin D 2 / Q000097:blood*; D000328:Adult; D000367:Age Factors; D001513:Beds; D015519:Bone Density; D006233:Persons with Disabilities; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007103:Immobilization; D008297:Male; D015675:Osteocalcin / Q000097:blood*; D010024:Osteoporosis / Q000097:blood* / Q000209:etiology
D015675:Osteocalcin; D015652:25-Hydroxyvitamin D 2