title: Wheelchair use and lipophilic statin medications may influence bone loss in chronic spinal cord injury: findings from the FRASCI-bone loss study.
abstract: We identified a protective bone effect at the knee with lipophilic statin use in individuals with chronic spinal cord injury. Lipophilic statin users gained bone at the knee compared to non-users and wheelchair users lost bone compared to walkers. Ambulation and or statins may be effective osteogenic interventions in chronic spinal cord injury (SCI).
  
  
  
  SCI increases the risk of osteoporosis and low-impact fractures, particularly at the knee. However, during the chronic phase of SCI, the natural history and factors associated with longitudinal change in bone density remain poorly characterized. In this study, we prospectively assessed factors associated with change in bone density over a mean of 21 months in 152 men and women with chronic SCI.
  
  
  
  A mixed model procedure with repeated measures was used to assess predictors of change in bone mineral density (PROC MIXED) at the distal femur and proximal tibia. Factors with a p value of <0.10 in the univariate mixed models, as well as factors that were deemed clinically significant (gender, age, and walking status), were assessed in multivariable models. Factors with a p value of ≤0.05 were included in the final model.
  
  
  
  We found no association between bone loss and traditional osteoporosis risk factors, including age, gender, body composition, or vitamin D level or status (normal or deficient). In both crude and fully adjusted models, wheelchair users lost bone compared to walkers. Similarly, statin users gained bone compared to nonusers.
  
  
  
  The statin finding is supported by reports in the general population where statin use has been associated with a reduction in bone loss and fracture risk. Our results suggest that both walking and statins may be effective osteogenic therapies to mitigate bone loss and prevent osteoporosis in chronic SCI. Our findings also suggest that loss of mechanical loading and/or neuronal factors contribute more to disuse osteoporosis than traditional osteoporosis risk factors.
authors.affiliation: Rocky Mountain Regional Spinal Injury System, Craig Rehabilitation Hospital, Englewood, CO, USA. leslie.morse@ucdenver.edu.|University of Colorado School of Medicine, Aurora, CO, USA. leslie.morse@ucdenver.edu.
authors.forename: L R
authors.initials: LR
authors.lastname: Morse
authors.affiliation: Spaulding-Harvard SCI Model System Center, Spaulding Rehabilitation Hospital, Boston, MA, USA.
authors.forename: N
authors.initials: N
authors.lastname: Nguyen
authors.affiliation: University of Colorado School of Medicine, Aurora, CO, USA.
authors.forename: R A
authors.initials: RA
authors.lastname: Battaglino
authors.affiliation: Massachusetts General Hospital Institute of Health Professions, Boston, MA, USA.
authors.forename: A J
authors.initials: AJ
authors.lastname: Guarino
authors.affiliation: VA Cooperative Studies Program, VA Boston Healthcare System, Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA.
authors.forename: D R
authors.initials: DR
authors.lastname: Gagnon
authors.affiliation: Spaulding-Harvard SCI Model System Center, Spaulding Rehabilitation Hospital, Boston, MA, USA.|Department of PMR, Harvard Medical School, Boston, MA, USA.
authors.forename: R
authors.initials: R
authors.lastname: Zafonte
authors.affiliation: Pulmonary, Allergy, Sleep, and Critical Care Medicine Section, Medical Service, VA Boston Healthcare System, Boston, MA, USA.|Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: E
authors.initials: E
authors.lastname: Garshick
mesh_terms: D015502:Absorptiometry, Photon; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015519:Bone Density; D001862:Bone Resorption / Q000517:prevention & control*; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000139:chemically induced*; D013119:Spinal Cord Injuries / Q000150:complications*; D016138:Walking; D016474:Weight-Bearing; D014910:Wheelchairs
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
keywords: Osteoporosis; Rehabilitation medicine; Spinal cord injury; Statin