The effects of spinal cord injury and exercise on bone mass: A literature review

Introduction: Bone loss is a common and often debilitating condition that accompanies spinal cord injury. Because bone loss after spinal cord injury is multifactorial, it can be difficult to assess and treat. This process becomes even more complex as secondary conditions associated with aging are introduced. Purpose: There are two purposes of this literature review. The first is to summarize information concerning the mechanisms of bone loss and osteoporosis after spinal cord injury. The second is to summarize existing data concerning the effects of exercise on bone loss after spinal cord injury. Method: Literature was reviewed concerning the bone loss process and the non-pharmacological treatment options for ameliorating bone loss after spinal cord injury. Results: (Part One) Osteoporosis is universal in persons with chronic complete spinal cord injury, which increases the risk of bone fracture. Bone loss after spinal cord injury is both sublesional and regional with the greatest areas of bone demineralization being in the sublesional trabecular laden areas of the distal and proximal epiphyses of the femur and tibia. (Part Two) While passive weight bearing of paralyzed lower extremities appears to be ineffective, stressing the bones through muscular contractions initiated by electrical stimulation (FES) have yielded positive results in some cases. The intensity, frequency, and duration of stress to the bones appear to be important determinants of improved bone parameters. Although further quantification of these components is needed, some generalized guidelines can be deduced from completed research. Intensities showing positive results have been loads of one to one and a half times body weight for FES exercise or having participants FES cycle at their highest power output. Safety precautions must be used to decrease risk of bone fracture. Generally, the frequency is effective with three or more weekly exercise sessions. Studies of duration suggest that several months to one or more years of FES are necessary. Discussion: In order to promote healthy and independent aging in patients with spinal cord injury, it is important to understand the processes, consequences and effective treatments involved with bone loss.