Paralysis & bone health

Paralysis & bone health

Posted by AskNurseLinda on Apr 25, 2016 11:13 am

Bone healthMaintaining good bone health is one of the hidden complications of spinal cord injury. It is hidden until suddenly you have a broken bone and wonder how did this happen? Sometimes the break is not obvious so you might have a broken bone and not even know it. Or you might suddenly develop other symptoms like swelling in an extremity, increased spams or events of AD (Autonomic Dysreflexia) as the result of the break. A broken bone in medical terms is called a ‘fracture’. Losing minerals, especially calcium from the bones is called osteoporosis.

Immediately upon having a spinal cord injury from trauma, many chemical changes occur as the body will try to protect the injured area. The trauma will create what is termed ‘a cascade of events’ that include neurological events but also there are hormonal reactions. It is the reaction of hormones to this trauma that create a new environment within the body that will allow minerals, especially calcium to leak out of the bone structure. The extra calcium will appear in your bloodstream in just a matter of hours. Eventually, the calcium is excreted in urine. Sometimes when catheterizing or looking at urine in the catheter bag, you can actually see the sediment or white calcium collected in the urine.

Spinal cord injury from a metabolic disease such as multiple sclerosis or any of the other neurological diseases, typically has a much slower onset of calcium leaving the bones. This is because of the slower trajectory or projection of the disease. Typically this means that bone mineral loss may develop later but there are many factors that can lead to early osteoporosis.

Bones look solid to the naked eye but they really have many microscopic air pockets in them. When minerals, especially calcium is not retained in the bones, these air pockets become larger. Eventually, the bone structure looks like it is moth eaten with tiny holes in the bones. The more holes and the larger these holes become, the less strength a bone has. Eventually, the strength of the bone becomes so weak that a fall, dropping of a limb or even just gently moving the limb can lead to it breaking.

Besides the endocrine system or hormones affecting the calcium and minerals to strengthen bone, lack of use is a culprit in osteoporosis. Immobility or even just lying in bed can lead to bone loss for anyone. People who get the flu and spend a couple of days in bed will have some decrease in strength when they return to their usual routing. The bones require muscles to pull on them and weight to be put through them to maintain their strength and bone health. Every movement we make requires a muscle to contract. As the muscle contracts it pulls on our bones. This happens in the legs and feet, arms and hands and in our head, neck, and torso. The muscles pulling on the bones increases their strength. The less mobile people are, the more opportunity for osteoporosis to develop.

There are other risk factors. The one that comes to mind when thinking about osteoporosis is older women who have wrist fractures from falls. That is the most common picture of a person with osteoporosis. Older women are at risk because of changes in their endocrine system that leads to hormone changes producing less ability to hold minerals in the bones. Other risk factors are a sedentary lifestyle which is thrust upon you with a spinal cord injury by not standing or moving.

Being thin is a risk factor. Heavier people who have mobility have less risk for osteoporosis because they are moving so much weight when they walk. This makes a heavier pull on those muscles which strengthens bones. This advantage is not to your benefit because carrying too much weight brings other serious health concerns. If you are immobile, the extra weight does not improve bone strength since you are not using those muscles.

Poor nutrition, diabetes, too much alcohol and caffeine, not getting enough calcium in your diet, all lead to osteoporosis. Smoking is a significant risk factor. Even being light skinned and blonde are risk factors that are inherited. Adding immobility further increases the complications of these risk factors.

Immobility is a key determinant for development of osteoporosis for individuals with spinal cord injury from trauma or disease. Men are equally as affected as women because without moving, the muscles are not pulling on the bones which weakens them. This is one condition where low bone density is an equal factor for men and women as after spinal cord injury, male hormones often change in testosterone levels. Osteoporosis is an equal gender complication after spinal cord injury or for those with immobility from any medical condition.

Interestingly enough, those with paraplegia may have bone loss in their legs due to immobility but normal bone density in their arms which are greatly used in mobility. Even though the full reason for the bone demineralization from hormonal changes is not fully understood, immobility is definitely a clear factor.

A bone scan or DEXA scan or CT scan is the test for bone density. This is an absolutely painless test. You have to lay on a table for a short amount of time while a wand circles your body. The density of your bone is measured in key areas. The bone density test should be done one time a year. If your bone density is normal, great. If it is just a little lower than standards, osteopenia is diagnosed. Osteopenia is slight bone mineral loss. Osteoporosis is major bone loss.

If you have the diagnosis of osteopenia or osteoporosis, you can take measures to treat the problem. Medications are available that can help you rebuild your bone density. These maybe necessary to avoid a broken bone or fracture from even the slightest of movements to your extremity in transferring or turning. It takes time for these medications to work.

Medications are available specifically for treatment of osteoporosis. Bone is like skin in that it is always replacing itself. Medications can stimulate an increase in the replacement of bone and slow the breakdown of old bone. This is all done on a microscopic level. Anabolic drugs and hormone therapy can also help rebuild bone. Both of these types of medication have to be prescribed by a healthcare professional and you have to be monitored when you are taking these medications to ensure you are receiving the correct amount. The medications are taken in various routes, some a pill by mouth and some through an IV in the medical office.

Besides medications, there are things you can do to help yourself to prevent ever developing osteoporosis. First, eat a balanced diet that includes dairy products. This can be a bit tricky as you do not want to consume so much calcium that you actually put too much in your body. A balanced, realistic diet is best.

Calcium supplements can be added as necessary after discussing this with your healthcare professional. Too much calcium is called hypercalcemia which can lead to heart and neurological problems as well as kidney stones. You can see this is not something you want to treat yourself but with the help of a healthcare professional, be sure to have lab values assessed to be sure you are within normal ranges.

Exercise is a natural treatment for bone loss. Range of motion or moving the extremity and body through the full range of the joint causes the muscle to pull on the bone. Range of motion exercises both actively and passively have many great benefits to your body including reducing spasms, and keeping your bones and joints in a general state of good health. It should be a natural part of your day.

Standing is an excellent therapy for individuals with spinal cord injury. This is because weight is put through your long bones of your legs which helps with the bone turn over. Standing will strengthen the bones in your legs. Most payors will support a standing frame so individuals who cannot stand on their own can be supported into the standing position. You may need your healthcare professional to write a letter of medical necessity to get a standing frame from your payor. There is evidence to support the benefit of this therapy which can be done in the home. If you need a special request for payment of this type, expect a rejection at the first asking. An appeal is generally needed before obtaining the therapy.

Functional electrical stimulation is particularly excellent for prevention and treatment of osteoporosis as the therapy provides stimulation to the muscles to form their own contraction thereby pulling on the bones to increase their strength. Not everyone has access to this type of therapy but many researchers and healthcare providers are advocating for this. My hope it that it soon becomes more widely available.

If you do have a fracture from osteoporosis, you might not even notice it at first. Typically, when osteoporosis weakens the bones so much, even a slight movement can lead to a bone fracture. You will not hear a break nor might you see a displacement of the bone. Your body will still react to a disruption in the skeletal system, even if you do not have sensation in that area. Some of the body’s responses to a fracture are similar to what you see in smaller traumas where swelling will occur to protect the site of the injury. The symptoms of a fracture might be swelling, a warm sensation over the area, redness, increased spasms or AD. You may not even notice any change at all. Treatment of the fracture is a cast or splint just as it would be for anyone. If the fracture is extremely displaced or severe, you might need surgery to repair it. Unfortunately, this is often not able to be performed for individuals with osteoporosis as the bone becomes so full of those little holes that there is no place to connect one end of the fractured bone to the other end of the bone. The insertion of a plate and screws which is a surgical repair of a fracture, will lead to further damage from the poor bone structure. This is an unfortunate situation which requires the individual to wait months while treatment of the osteoporosis is corrected before the fracture can heal.

Preventing osteoporosis is a necessity for those with spinal cord injury. Vigilant monitoring is necessary to keep in check to prevent bone fractures and to keep osteoporosis from developing. Keeping up with your bone density is a must as it is much easier to correct density issues before they become a significant issue.

dcff8f8580461852c2857fc66f7e5ff8-huge-nuI'm online in this community every Wednesday from 8-9 PM ET to answer your SCI and paralysis related questions.

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Re: Paralysis & bone health

Posted by Lorri on Apr 26, 2016 11:41 am

I completely agree that we need to keep our health and fitness going. I'm currently riding a recumbent bike at home. I also do some floor exercises. Are there any good suggestions to burn fat? I became paralyzed one year ago and have put on 8lbs. I really want to get that weight off. I do stay active and even have a beautiful garden that I work in almost daily. I also volunteer at the Hospital with Tramua Surviors and talk to them about there new way of life. I'm on the Board/Treasure in my neighborhood. 

Lorri J Taylor

Re: Paralysis & bone health

Posted by AskNurseLinda on Apr 26, 2016 9:05 pm

Hi, Lorri, Losing fat is done by one formula only, burning more calories than what is taken in. Pounds are pesky, It is difficult with mobility issues to burn enough calories. You are doing your best with all of your activity. The next stop might be to ask for a nutritional consult. The key is to maintain your nutritional value in your diet to avoid complications especially skin breakdown. Since your activity level is so high, diet would be the next challenge. Good luck. You are motivated to be able to achieve your goal. Nurse Linda

Re: Paralysis & bone health

Posted by KateS on Nov 6, 2017 3:01 pm

Thanks for information!

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