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Yovchev I, Maayan C, Simanovsky N, Foldes AJ, Brooks R, Kaplan L, Meiner Z, Cheishvili D. The Relationship Between Scoliosis, Spinal Bone Density, and Truncal Muscle Strength in Familial Dysautonomia Patients. Calcif Tissue Int 2024; 114:222-227. [PMID: 38030713 DOI: 10.1007/s00223-023-01164-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 11/09/2023] [Indexed: 12/01/2023]
Abstract
This combined retrospective and prospective study aimed to investigate the relationship between scoliosis, spinal bone mineral density (BMD), and truncal muscle strength in patients with familial dysautonomia (FD). A total of 79 FD patients (40 male, 39 female) aged 5-44 years were included. The severity of scoliosis, lumbar spine BMD (Z-score), and truncal muscle strength were assessed. Correlations were analyzed using Pearson's correlation coefficient. Inverse correlations were observed between scoliosis severity and BMD (r = - 0.328, p = 0.001), as indicated by increasingly negative Z-score values with worsening osteoporosis. There were also inverse correlations between scoliosis and truncal muscle strength (r = - 0.595, p < 0.001). The correlation between scoliosis and age was notable up to 22 years (r = 0.421, p = 0.01), but not in the older age group (22-44 years). Our study identified inverse correlations between osteoporosis and scoliosis, as well as between scoliosis and truncal muscle strength, in FD patients. These findings suggest that there may be a relationship between bone density, muscle strength, and the severity of spinal curvature in this population. While our results highlight the potential importance of early diagnosis and management of osteoporosis, and possibly the benefits of physical therapy to strengthen truncal muscles, further research is needed to determine the direct impact of these interventions on preventing the progression of scoliosis and its associated complications in FD patients. A long-term longitudinal study could provide more insights into these relationships and inform treatment strategies for FD patients.
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Affiliation(s)
- I Yovchev
- Department of Rehabilitation, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Ch Maayan
- Department of Pediatrics, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - N Simanovsky
- Department of Medical Imaging, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - A J Foldes
- Osteoporosis Center, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - R Brooks
- Department of Pediatrics, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - L Kaplan
- Osteoporosis Center, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Z Meiner
- Department of Rehabilitation, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - D Cheishvili
- Department of Pediatrics, Hadassah Hebrew University Medical Center, Jerusalem, Israel.
- Gerald Bronfman Department of Oncology, McGill University, Montréal, QC, Canada.
- HKG Epitherapeutics, Unit 313-315, 3/F Biotech Center 2, 11 Science Park West Avenue, Shatin, Hong Kong.
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Liu Y, Liu Y, Huang Y, Le S, Jiang H, Ruan B, Ao X, Shi X, Fu X, Wang S. The effect of overweight or obesity on osteoporosis: A systematic review and meta-analysis. Clin Nutr 2023; 42:2457-2467. [PMID: 37925778 DOI: 10.1016/j.clnu.2023.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 08/17/2023] [Accepted: 10/13/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND Osteoporosis and obesity are closely related, and the relationships between different types of obesity and osteoporosis are inconsistent. OBJECTIVE Our objective was to summarize earlier data concerning the association between osteoporosis and obesity (general and central), and to compare the impacts of these two obesity indicators on osteoporosis. METHODS From inception to May 2021, a comprehensive search in electronic bibliographic databases was conducted, and the search was updated in December 2021, July 2022 and June 2023. The data were independently extracted and evaluated by two investigators from epidemiological studies that reported the impact of obesity on the odds of incident osteoporosis. RESULTS There were 24 studies included in the final analysis when it came to general obesity measured by body mass index (BMI). Individuals with overweight and obesity had decreased odds of osteoporosis (odds ratio (OR), 0.451, 95% confidence intervals (CIs): 0.366-0.557). Sensitivity analyses showed that both overweight and obesity were decreased odds of osteoporosis, with reductions of 48.6% and 70.1%, respectively (OR, 0.514, 95% CI: 0.407-0.649; OR, 0.299, 95% CI: 0.207-0.433). Conversely, individuals classified as underweight were found to have higher odds of osteoporosis (OR, 2.540, 95% CI: 1.483-4.350). In term of central obesity, the final analysis consisted of 7 studies. No significant association was observed between central obesity and osteoporosis (OR, 0.913, 95% CI: 0.761-1.096). CONCLUSIONS General overweight and obesity were associated with lower odds of developing osteoporosis, whereas underweight was associated with higher odds. However, central obesity did not show a significant association with osteoporosis. These findings underscore the importance of considering the impact of obesity on osteoporosis. Further research is necessary to reinforce the evidence and validate our findings.
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Affiliation(s)
- Yupeng Liu
- Department of Epidemiology and Biostatistics, School of Public Health and Management of Wenzhou Medical University, Wenzhou, China
| | - Yi Liu
- Department of Nutrition and Food Hygiene, School of Public Health and Management of Wenzhou Medical University, Wenzhou, China
| | - Yufeng Huang
- Department of Nutrition and Food Hygiene, School of Public Health and Management of Wenzhou Medical University, Wenzhou, China
| | - Siyu Le
- Department of Nutrition and Food Hygiene, School of Public Health and Management of Wenzhou Medical University, Wenzhou, China
| | - Huinan Jiang
- Department of Nutrition and Food Hygiene, School of Public Health and Management of Wenzhou Medical University, Wenzhou, China
| | - Binye Ruan
- Department of Nutrition and Food Hygiene, School of Public Health and Management of Wenzhou Medical University, Wenzhou, China
| | - Xuemei Ao
- Department of Nutrition and Food Hygiene, School of Public Health and Management of Wenzhou Medical University, Wenzhou, China
| | - Xudong Shi
- Department of Nutrition and Food Hygiene, School of Public Health and Management of Wenzhou Medical University, Wenzhou, China
| | - Xiaoyi Fu
- Department of Nutrition and Food Hygiene, School of Public Health and Management of Wenzhou Medical University, Wenzhou, China.
| | - Shuran Wang
- Department of Nutrition and Food Hygiene, School of Public Health and Management of Wenzhou Medical University, Wenzhou, China.
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Genêt F, Salga M, De Brier G, Jouvion AX, Genêt G, Lofaso F, Prigent H, Obrecht M, Dziri S, Théfenne L. Accuracy of Resting Energy Expenditure Estimation Equations in Polio Survivors. Arch Phys Med Rehabil 2023; 104:418-424. [PMID: 36270514 DOI: 10.1016/j.apmr.2022.09.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 09/15/2022] [Accepted: 09/25/2022] [Indexed: 11/02/2022]
Abstract
OBJECTIVE To evaluate the accuracy of 4 equations validated for the general population to determine resting energy expenditure (REE) in polio survivors. DESIGN A descriptive, ambispective, single-center observational cohort study of minimal risk care. SETTING Tertiary university care hospital. PARTICIPANTS DATAPOL database of polio survivors followed up in a specialist department (N=298). INTERVENTIONS None. MAIN OUTCOMES MEASURES REE measurement by indirect calorimetry and estimated REE using 4 equations and comparing the values with indirect calorimetry. Analysis of correlations between measured REE and weight, height, and body mass index (BMI) and indicators of severity of polio sequelae. RESULTS Of the 298 polio cases in the database between January 2014 and May 2017, 41 were included (19 men and 22 women). Mean±SD BMI was 26.0±5.6 kg/m2 (56.1% below 25). Measured REE correlated significantly and positively with weight and weaker with BMI. Correlations between measured and estimated REE were strong (between 0.49 and 0.59); correlations were strongest for the simplified World Health Organization and the Harris and Benedict equations. However, the equations systematically overestimated REE by more than 20%, especially in men. We calculated a correction factor for the World Health Organization scale: -340.3 kcal/d for women and -618.8 kcal/d for men. CONCLUSION Analysis of REE is important for polio survivors; The use of estimation equations could lead to the prescription of a nonadapted diet. We determined a correction factor that should be validated in prospective studies.
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Affiliation(s)
- François Genêt
- Université Versailles-Saint-Quentin-en-Yvelines, "End:icap" U1179 Inserm, UFR des sciences de la santé-Simone-Veil, Versailles, France; Département Parasport Santé, Service de médecine physique et de réadaptation, Hôpital Raymond-Poincaré, Assistance Publique-Hôpitaux de Paris (AP-HP), Garches, France; UPOH (Unité Péri Opératoire du Handicap, Perioperative Disability Unit), Service de médecine physique et de réadaptation, Hôpital Raymond-Poincaré, Assistance Publique-Hôpitaux de Paris (AP-HP), Garches, France.
| | - Marjorie Salga
- Université Versailles-Saint-Quentin-en-Yvelines, "End:icap" U1179 Inserm, UFR des sciences de la santé-Simone-Veil, Versailles, France; Département Parasport Santé, Service de médecine physique et de réadaptation, Hôpital Raymond-Poincaré, Assistance Publique-Hôpitaux de Paris (AP-HP), Garches, France; UPOH (Unité Péri Opératoire du Handicap, Perioperative Disability Unit), Service de médecine physique et de réadaptation, Hôpital Raymond-Poincaré, Assistance Publique-Hôpitaux de Paris (AP-HP), Garches, France
| | - Gratiane De Brier
- Service de médecine physique et de réadaptation, Hôpital d'Instruction des Armées Laveran, Marseille, France
| | - Arnaud-Xavier Jouvion
- Service de médecine physique et de réadaptation, Hôpital d'Instruction des Armées Laveran, Marseille, France
| | - Guillaume Genêt
- Université Versailles-Saint-Quentin-en-Yvelines, "End:icap" U1179 Inserm, UFR des sciences de la santé-Simone-Veil, Versailles, France; Département Parasport Santé, Service de médecine physique et de réadaptation, Hôpital Raymond-Poincaré, Assistance Publique-Hôpitaux de Paris (AP-HP), Garches, France
| | - Frédéric Lofaso
- Université Versailles-Saint-Quentin-en-Yvelines, "End:icap" U1179 Inserm, UFR des sciences de la santé-Simone-Veil, Versailles, France; Service de médecine physique et de réadaptation, Hôpital d'Instruction des Armées Laveran, Marseille, France; Service d'explorations fonctionnelles, Hôpital Raymond-Poincaré, Assistance Publique-Hôpitaux de Paris (AP-HP), Garches, France
| | - Hélène Prigent
- Université Versailles-Saint-Quentin-en-Yvelines, "End:icap" U1179 Inserm, UFR des sciences de la santé-Simone-Veil, Versailles, France; Service d'explorations fonctionnelles, Hôpital Raymond-Poincaré, Assistance Publique-Hôpitaux de Paris (AP-HP), Garches, France
| | - Maxime Obrecht
- Service de médecine physique et de réadaptation, Hôpital d'Instruction des Armées Laveran, Marseille, France
| | - Sophie Dziri
- Université Versailles-Saint-Quentin-en-Yvelines, "End:icap" U1179 Inserm, UFR des sciences de la santé-Simone-Veil, Versailles, France; UPOH (Unité Péri Opératoire du Handicap, Perioperative Disability Unit), Service de médecine physique et de réadaptation, Hôpital Raymond-Poincaré, Assistance Publique-Hôpitaux de Paris (AP-HP), Garches, France
| | - Laurent Théfenne
- Université Versailles-Saint-Quentin-en-Yvelines, "End:icap" U1179 Inserm, UFR des sciences de la santé-Simone-Veil, Versailles, France; Military Educational Establishment of the Army Health Service, Ecole du Val de Grâce, 1 Pl. Alphonse Laveran, 75005 Paris, France
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Gupta A, Saurabh S, Trikha T, Karpe A, Mittal S. Femoral Shaft Fracture in Post-polio Syndrome Patients: Case Series from a Level-I Trauma Center and Review of Literature. Indian J Orthop 2022; 56:1339-1346. [PMID: 35928657 PMCID: PMC9283591 DOI: 10.1007/s43465-022-00683-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 06/06/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Femoral shaft fracture in patients of post-polio syndrome (PPS) represents an uncommon yet complex injury pattern. Poorly developed soft-tissue envelope, decreased muscle bulk, reduced vascularity, regional osteopenia, joint contractures, and altered bony anatomy impose significant surgical challenges. Thorough pre-operative planning is imperative as each case requires individualized approach and method of fixation. The aim of the study was to analyze the clinical outcomes in such patients following fracture fixation and to assess the surgical challenges encountered and provide solutions. MATERIALS AND METHODS A retrospective case series of 33 patients with femoral shaft fracture in PPS limbs was undertaken. Mode of injury, method of fixation, surgical time, intra-operative blood loss, union time, and complications were recorded. RESULTS Low-energy fall was the most common mechanism of injury (73%). Thirty-three patients underwent fixation with intramedullary nailing being the most common mode (79%). Femoral canal diameter, femoral bow, fracture location and morphology and clinical deformities of the patients are key governing factors that determine the choice of implant. Locking plates, pre-contoured anatomical plates, and titanium elastic nailing system offer an alternative in patients unsuitable for nailing. With no difference between various implants, average time for bone healing was 13.8 ± 4.4 weeks. All patients resumed full weight-bearing mobilization and returned to pre-injury activity status at the end of 6 months post-surgery. CONCLUSION With detailed pre-operative work-up, contemplating intra-operative difficulties, individualized surgical plan, careful handling of soft tissues, and availability of back-up implants, good clinical outcomes can be achieved in femur fractures in PPS patients.
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Affiliation(s)
- Anupam Gupta
- Department of Orthopaedics, All India Institute of Medical Sciences, JPNATC, AIIMS, New Delhi, India
| | - Suman Saurabh
- Department of Orthopaedics, All India Institute of Medical Sciences, JPNATC, AIIMS, New Delhi, India
| | - Tanya Trikha
- Mahatma Gandhi Mission Medical College and Hospital, Aurangabad, India
| | | | - Samarth Mittal
- Department of Orthopaedics, All India Institute of Medical Sciences, JPNATC, AIIMS, New Delhi, India
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Shapiro LT, Sherman AL. Medical Comorbidities and Complications Associated with Poliomyelitis and Its Sequelae. Phys Med Rehabil Clin N Am 2021; 32:591-600. [PMID: 34175017 DOI: 10.1016/j.pmr.2021.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Survivors of poliomyelitis may experience long-term sequelae that put them at increased risk for injury, pain, cardiovascular deconditioning, and functional decline. Osteoporotic fractures and entrapment neuropathies, in particular, may result in greater impairments in one's mobility and ability to perform activities of daily living. Dysphagia may necessitate the use of compensatory swallow strategies to minimize aspiration risk. Comorbid conditions, including hypertension, dyslipidemia, obesity, and stroke, are also very prevalent in this population. Risk factor modification, including diet, exercise, and medication compliance, is essential to achieve optimal health and function among survivors of poliomyelitis.
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Affiliation(s)
- Lauren T Shapiro
- Department of Physical Medicine and Rehabilitation, University of Miami Leonard M. Miller School of Medicine, PO Box 016960 (C-206), Miami, FL 33101, USA.
| | - Andrew L Sherman
- Department of Physical Medicine and Rehabilitation, University of Miami Leonard M. Miller School of Medicine, PO Box 016960 (C-206), Miami, FL 33101, USA
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6
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Murphy OC, Messacar K, Benson L, Bove R, Carpenter JL, Crawford T, Dean J, DeBiasi R, Desai J, Elrick MJ, Farias-Moeller R, Gombolay GY, Greenberg B, Harmelink M, Hong S, Hopkins SE, Oleszek J, Otten C, Sadowsky CL, Schreiner TL, Thakur KT, Van Haren K, Carballo CM, Chong PF, Fall A, Gowda VK, Helfferich J, Kira R, Lim M, Lopez EL, Wells EM, Yeh EA, Pardo CA. Acute flaccid myelitis: cause, diagnosis, and management. Lancet 2021; 397:334-346. [PMID: 33357469 PMCID: PMC7909727 DOI: 10.1016/s0140-6736(20)32723-9] [Citation(s) in RCA: 67] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 09/15/2020] [Accepted: 09/17/2020] [Indexed: 12/20/2022]
Abstract
Acute flaccid myelitis (AFM) is a disabling, polio-like illness mainly affecting children. Outbreaks of AFM have occurred across multiple global regions since 2012, and the disease appears to be caused by non-polio enterovirus infection, posing a major public health challenge. The clinical presentation of flaccid and often profound muscle weakness (which can invoke respiratory failure and other critical complications) can mimic several other acute neurological illnesses. There is no single sensitive and specific test for AFM, and the diagnosis relies on identification of several important clinical, neuroimaging, and cerebrospinal fluid characteristics. Following the acute phase of AFM, patients typically have substantial residual disability and unique long-term rehabilitation needs. In this Review we describe the epidemiology, clinical features, course, and outcomes of AFM to help to guide diagnosis, management, and rehabilitation. Future research directions include further studies evaluating host and pathogen factors, including investigations into genetic, viral, and immunological features of affected patients, host-virus interactions, and investigations of targeted therapeutic approaches to improve the long-term outcomes in this population.
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Affiliation(s)
- Olwen C Murphy
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Kevin Messacar
- Department of Pediatric Infectious Diseases, Children's Hospital Colorado, Aurora, CO, USA
| | - Leslie Benson
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Riley Bove
- Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA
| | - Jessica L Carpenter
- Department of Neurology, Children's National Health System, Washington, DC, USA
| | - Thomas Crawford
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Janet Dean
- International Center for Spinal Cord Injury, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Roberta DeBiasi
- Department of Pediatric Infectious Diseases, Children's National Health System, Washington, DC, USA
| | - Jay Desai
- Division of Neurology, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Matthew J Elrick
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Raquel Farias-Moeller
- Department of Neurology, Children's Hospital of Wisconsin and the Medical College of Wisconsin, Milwaukee, WI, USA
| | - Grace Y Gombolay
- Department of Neurology, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA
| | - Benjamin Greenberg
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Matthew Harmelink
- Department of Neurology, Children's Hospital of Wisconsin and the Medical College of Wisconsin, Milwaukee, WI, USA
| | - Sue Hong
- Division of Pediatric Critical Care, Ann & Robert H Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Sarah E Hopkins
- Division of Neurology, Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Joyce Oleszek
- Department of Physical Medicine and Rehabilitation, Children's Hospital Colorado, Aurora, CO, USA
| | - Catherine Otten
- Department of Pediatric Neurology, Seattle Children's Hospital, Seattle, WA, USA
| | - Cristina L Sadowsky
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA; International Center for Spinal Cord Injury, Kennedy Krieger Institute, Baltimore, MD, USA
| | - Teri L Schreiner
- Department of Child Neurology, Children's Hospital Colorado, Aurora, CO, USA
| | - Kiran T Thakur
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
| | - Keith Van Haren
- Department of Neurology and Neurological Sciences, Stanford University, Stanford, CA, USA
| | - Carolina M Carballo
- Department of Infectious Diseases, Hospital de Niños "Ricardo Gutiérrez", Buenos Aires, Argentina
| | - Pin Fee Chong
- Department of Pediatric Neurology, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Amary Fall
- Institut Pasteur de Dakar, Département de Virologie, Dakar, Senegal
| | - Vykuntaraju K Gowda
- Department of Pediatric Neurology, Indira Gandhi Institute of Child Health, Bangalore, Karnataka, India
| | - Jelte Helfferich
- Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Ryutaro Kira
- Department of Pediatric Neurology, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Ming Lim
- Children's Neuroscience Center, Evelina London Children's Hospital, Guy's and St Thomas' NHS Trust, and Faculty of Life Sciences, King's College, London, UK
| | - Eduardo L Lopez
- Department of Infectious Diseases, Hospital de Niños "Ricardo Gutiérrez", Buenos Aires, Argentina
| | - Elizabeth M Wells
- Department of Neurology, Children's National Health System, Washington, DC, USA
| | - E Ann Yeh
- Division of Neurology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, ON, Canada
| | - Carlos A Pardo
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Sherf RM, Cantrell D, Or K, Marcus E, Shapira A, Benbassat C, Ish-Shalom S, Koren R. The Risk of Bone Fractures in Post-Poliomyelitis Patients Transitioning to Middle Adulthood. Endocr Pract 2020; 26:1277-1285. [PMID: 33471657 DOI: 10.4158/ep-2020-0102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 06/01/2020] [Indexed: 11/15/2022]
Abstract
ObjectiveWhile osteoporotic fractures are reported in up to 40% of adults with post-poliomyelitis syndrome (PPS), clinical guidelines regarding bone mineral density (BMD) and indications for treatment are scarce. We investigated the characteristics of PPS patients, focusing on fractures and osteoporosis as the primary outcomes. METHODS A cross-sectional retrospective data analysis from medical records of 204 PPS patients regarding their clinical characteristics and long-term outcome, with emphasis on bone metabolism status. RESULTS Our cohort included 53% women; mean age was 65 years at study entry and 1.7 years at the diagnosis of acute poliomyelitis. The lower limb was involved in 97.5% of patients, and the BMD in the affected limb tended to be lower than the unaffected, with a mean T-score of -1.64 vs. -1.19, respectively (P = .06). Recurrent falls were documented in 39.2% of patients, and osteoporosis in 20.6%, being more frequent in women (P = .003) and patients with fractures (P = .002). At least one fracture occurred in 52.2% of patients, and more than one in 40.3%. The median age for the first fracture was 57.5 years (range, 30 to 83 years), and most fractures occurred in the affected limb (73.2%). CONCLUSIONS Underdiagnosis and delayed treatment of osteoporosis in late-adulthood post-poliomyelitis patients underlie the need for comprehensive clinical guidelines to manage these patients, including recommendations on bone health assessment, medical treatment, and their inclusion as a high-risk group for bone fractures.
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Affiliation(s)
- Rutie Mamlok Sherf
- Internal Medicine A, Shamir Medical Center (formerly Assaf Harofeh), Zerifin
| | - Dror Cantrell
- Endocrine Institute, Shamir Medical Center (formerly Assaf Harofeh), Zerifin; Internal Medicine C, Shamir Medical Center (formerly Assaf Harofeh), Zerifin
| | - Karen Or
- Internal Medicine A, Shamir Medical Center (formerly Assaf Harofeh), Zerifin; Endocrine Institute, Shamir Medical Center (formerly Assaf Harofeh), Zerifin
| | - Efrat Marcus
- Endocrine Institute, Shamir Medical Center (formerly Assaf Harofeh), Zerifin
| | - Alex Shapira
- Polio Clinic Department of Orthopedics, Shamir Medical Center (formerly Assaf Harofeh), Zerifin
| | - Carlos Benbassat
- Endocrine Institute, Shamir Medical Center (formerly Assaf Harofeh), Zerifin; Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv.
| | | | - Ronit Koren
- Endocrine Institute, Shamir Medical Center (formerly Assaf Harofeh), Zerifin; Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv
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8
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Garceau SP, Igbokwe EN, Warschawski Y, Neufeld ME, Safir OA, Wade JP, Guy P, Wolfstadt JI. Management Options and Outcomes for Patients with Femoral Fractures with Post-Polio Syndrome of the Lower Extremity: A Critical Analysis Review. JBJS Rev 2020; 8:e0146. [PMID: 32487976 DOI: 10.2106/jbjs.rvw.19.00146] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Post-polio syndrome is characterized by a late functional deterioration (usually after >=15 years from the initial infection) in patients with a history of paralytic poliomyelitis infection, and it is defined by the March of Dimes criteria. Patients with post-polio syndrome are at increased risk for falls and associated hip and femoral fractures as a result of lower bone mineral density, decreased lean muscle mass, and musculoskeletal deformities.
Current evidence suggests that treatment modalities for femoral fractures should emphasize fixation that allows early progressive weight-bearing and ambulation to optimize functional outcomes. Good results after hip arthroplasty have been described with both cemented and uncemented implants in patients who have been treated for osteoarthritis, but there has been little evidence guiding hip fracture management. Anatomic challenges that are encountered are osteoporotic bone, a valgus neck-shaft angle, increased femoral anteversion, and a small femoral canal diameter.
Intramedullary nailing of hip and femoral fractures can be challenging due to the small femoral canal diameter that frequently is encountered. Alternative methods of fixation have shown promising results. These include the use of sliding hip screws for hip fracture management and fixed-angle locking plates for hip and femoral fracture management.
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Affiliation(s)
- Simon P Garceau
- Division of Orthopaedics, Joseph and Wolf Lebovic Health Complex, Mount Sinai Hospital, Toronto, Ontario, Canada
| | | | - Yaniv Warschawski
- Division of Orthopaedics, Joseph and Wolf Lebovic Health Complex, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Michael E Neufeld
- Division of Orthopaedics, Department of Adult Joint Reconstruction, Western University, London, Ontario, Canada
| | - Oleg A Safir
- Division of Orthopaedics, Joseph and Wolf Lebovic Health Complex, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - John P Wade
- Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Pierre Guy
- Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jesse I Wolfstadt
- Division of Orthopaedics, Joseph and Wolf Lebovic Health Complex, Mount Sinai Hospital, Toronto, Ontario, Canada
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9
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Grill B, Levangie PK, Cole M, Rosenberg D, Jensen L. Bone Mineral Density Among Individuals With Residual Lower Limb Weakness After Polio. PM R 2019; 11:470-475. [DOI: 10.1016/j.pmrj.2018.08.387] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 08/18/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Beth Grill
- Spaulding Outpatient Center Framingham MA
| | - Pamela K. Levangie
- MGH Institute of Health ProfessionsBoston, MA; and 500 Lexington Street, Unit 3 Woburn, MA 01801
| | - Maria Cole
- Spaulding Outpatient Center Framingham MA
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Wu CH, Huang SW, Lin YN, Wang CY, Liou TH, Chang KH. Adults with polio are at risk of hip fracture from middle age: A nationwide population-based cohort study. Injury 2019; 50:738-743. [PMID: 30797541 DOI: 10.1016/j.injury.2019.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Accepted: 02/07/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Having motor impairment since childhood and being at risk of osteoporosis and falls, adults with polio would be more likely to suffer a hip fracture (HF) and may experience different epidemiological characteristics from the general population. OBJECTIVE To estimate the risk and incidence of HF in adults with polio. DESIGN Using a national database, we conducted a population-based cohort study. We identified patients with polio using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code of 138. For each patient with polio, we randomly selected five age- and sex-matched control subjects. Those subjects aged <40 years were excluded. We analyzed participants aged 40˜64 years (middle-aged) and subjects aged ≥65 years (elderly) separately and recognized subjects who had an HF (ICD-9-CM code, 820) only when they received hospitalization to care for the illness from January 1, 2003 to December 31, 2008. RESULTS We identified 403 adults with polio (mean age ± standard deviation, 47.2 ± 8.6 years). Compared to the controls, patients with polio had a higher incidence of HF (all, 4.1 vs. 1.1/1000 person-years, p = 0.002; middle-aged, 2.3 vs. 0.3/1000 person-years, p < 0.001; male, 6.2 vs. 0.9/1000 person-years, p < 0.001); had a younger mean age (±standard deviation) of fracturing a hip (61.0±14.9 vs. 74.4±9.3 years, p = 0.015); had a lower cumulative HF-free probability (±standard error) before the age of 65 years (0.970±0.017 vs. 0.988±0.007, p<0.001) and throughout the study duration (0.415 ± 0.296 vs. 0.682 ± 0.158, p<0.001); and had a higher risk of HF, yielding an adjusted hazard ratio (95% confidence interval) of 3.58 (1.45˜8.79, p = 0.006). Patients with polio aged >48.2 years were likely to experience an HF. CONCLUSIONS Adults with polio are at risk of HF. A customized HF prevention program is important for people with polio. The program should be started early in middle-age and should include men.
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Affiliation(s)
- Chien-Hua Wu
- Department of Applied Mathematics, Chung-Yuan Christian University, Chung-Li, Taiwan
| | - Shih-Wei Huang
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan; Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yen-Nung Lin
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Department of Physical Medicine and Rehabilitation, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Chyan-Yeong Wang
- Department of Physical Medicine and Rehabilitation, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Tsan-Hon Liou
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan; Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Kwang-Hwa Chang
- Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Department of Physical Medicine and Rehabilitation, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, Taipei, Taiwan.
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Abstract
The purpose of the original study was to examine the use of whole body vibration (WBV) on polio survivors with and without post-polio syndrome as a form of weight bearing exercise. The goal of this article is to highlight the strengths, limitations, and applications of the method used. Fifteen participants completed two intervention blocks with a wash-out period in between the blocks. Each block consisted of twice a week (four weeks) WBV interventions, progressing from 10 to 20 min per session. Low intensity (peak to peak displacement 4.53 mm, frequency 24 Hz, g force 2.21) and higher intensity (peak to peak displacement 8.82 mm, frequency 35 Hz, g force 2.76) WBV blocks were used. Pain severity significantly improved in both groups following higher intensity vibration. Walking speed significantly improved in the group who participated in higher intensity intervention first. No study-related adverse events occurred. Even though this population can be at risk of developing overuse-related muscle weakness, fatigue, or pain from excessive physical activity or exercise, the vibration intensity levels utilized did not cause significant muscle weakness, pain, fatigue, or sleep disturbances. Therefore, WBV appears to provide a safe method of weight bearing exercise for this population. Limitations included the lack of measurement of reflexes, muscular activity, or circulation, the difficulty in participant recruitment, and insufficient strength of some participants to stand in recommended position. Strengths included a standard, safe protocol with intentional monitoring of symptoms and the heterogeneity of the participants in their physical abilities. An application of the methods is the home use of WBV to reduce the barriers associated with going to a facility for weight bearing exercise for longer term interventions, and benefits for conditions such as osteoporosis, particularly for aging adults with mobility difficulties due to paralysis or weakness. Presented method may serve as a starting point in future studies.
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Affiliation(s)
- Carolyn P Da Silva
- School of Physical Therapy, Texas Woman's University; Outpatient Medical Clinic, TIRR Memorial Hermann Rehabilitation and Research;
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Lo JK, Robinson LR. Postpolio syndrome and the late effects of poliomyelitis. Part 1. pathogenesis, biomechanical considerations, diagnosis, and investigations. Muscle Nerve 2018; 58:751-759. [DOI: 10.1002/mus.26168] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 05/06/2018] [Accepted: 05/08/2018] [Indexed: 01/18/2023]
Affiliation(s)
- Julian K. Lo
- Sunnybrook Health Sciences Centre; Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Toronto; 2075 Bayview Avenue, Toronto Ontario Canada
| | - Lawrence R. Robinson
- Sunnybrook Health Sciences Centre; Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Toronto; 2075 Bayview Avenue, Toronto Ontario Canada
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Kay L, Nielsen NM, Wanscher B, Ibsen R, Kjellberg J, Jennum P. Morbidity and mortality following poliomyelitis - a lifelong follow-up. Eur J Neurol 2016; 24:326-333. [PMID: 27869331 DOI: 10.1111/ene.13201] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 09/27/2016] [Indexed: 12/01/2022]
Abstract
BACKGROUND AND PURPOSE In the world today 10-20 million people are still living with late effects of poliomyelitis (PM), but the long-term consequences of the disease are not well known. The aim of this study was to describe lifelong morbidity and mortality among Danes who survived PM. METHODS Data from official registers for a cohort of 3606 Danes hospitalized for PM in the period 1940-1954 were compared with 13 762 age- and gender-matched controls. RESULTS Compared with controls, mortality was moderately increased for both paralytic as well as non-paralytic PM cases; Hazard Ratio, 1.31 (95% confidence interval, 1.18-1.44) and 1.09 (95% confidence interval, 1.00-1.19), respectively. Hospitalization rates were approximately 1.5 times higher among both paralytic and non-paralytic PM cases as compared with controls. Discharge diagnoses showed a broad spectrum of diseases. There were no major differences in morbidities between paralytic and non-paralytic PM cases. CONCLUSIONS Poliomyelitis has significant long-term consequences on morbidity and mortality of both paralytic and non-paralytic cases.
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Affiliation(s)
- L Kay
- Specialized Hospital for Polio and Accident Victims, Rødovre, Denmark
| | - N M Nielsen
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | - B Wanscher
- Department of Clinical Neurophysiology, Danish Center for Sleep Medicine, Glostrup Hospital, University of Copenhagen, Copenhagen, Denmark
| | - R Ibsen
- Danish Institute for Health Services Research, Copenhagen, Denmark
| | - J Kjellberg
- Danish Institute for Health Services Research, Copenhagen, Denmark
| | - P Jennum
- Department of Clinical Neurophysiology, Danish Center for Sleep Medicine, Glostrup Hospital, University of Copenhagen, Copenhagen, Denmark
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Gupta M, Jain VK, Upadhyaya GK, Arya RK. Comprehensive review of challenges associated with management of lower limb fractures in poliomyelitis patients. J Clin Orthop Trauma 2016; 7:276-281. [PMID: 27857503 PMCID: PMC5106482 DOI: 10.1016/j.jcot.2016.08.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Revised: 05/08/2016] [Accepted: 08/18/2016] [Indexed: 01/13/2023] Open
Abstract
Poliomyelitis is on the verge of eradication. But the survivors of polio are still living with its consequences in different parts of the world and so will continue to be seen for almost a century. Fractures in the polio-affected limb are a common entity in these patients and are difficult to manage using the common fracture management protocols. This article gives a comprehensive review of the challenges faced in fixation of fractures in polio affected limbs and possible solutions to overcome them. Knowledge of treating these fractures is important to a trauma surgeon as such scenarios are not uncommon in daily practice.
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Affiliation(s)
| | - Vijay Kumar Jain
- Corresponding author at: Department of Orthopedics, PGIMER Dr Ram Manohar Lohia Hospital, New Delhi 110001, India.Department of Orthopedics, PGIMER Dr Ram Manohar Lohia HospitalNew Delhi110001India
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Chang KH, Tseng SH, Lin YC, Lai CH, Hsiao WT, Chen SC. The relationship between body composition and femoral neck osteoporosis or osteopenia in adults with previous poliomyelitis. Disabil Health J 2015; 8:284-9. [DOI: 10.1016/j.dhjo.2014.09.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Revised: 09/25/2014] [Accepted: 09/27/2014] [Indexed: 11/24/2022]
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Review of secondary health conditions in postpolio syndrome: prevalence and effects of aging. Am J Phys Med Rehabil 2015; 94:139-45. [PMID: 25122095 DOI: 10.1097/phm.0000000000000166] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study sought to better understand the prevalence and the severity of secondary health conditions in individuals with postpolio syndrome (PPS) as well as the association between these conditions and aging. DESIGN A scoping literature review was conducted searching electronic databases for studies published from 1986 to 2011. The scoping review provided information regarding the prevalence and associations of secondary health conditions in PPS with age or other duration-related variables. RESULTS The findings indicate that (1) individuals with PPS experience a number of serious secondary health conditions; (2) the most common conditions or symptoms are fatigue, pain, respiratory and sleep complaints, and increased risk for falls; (3) reports of the associations between the frequency or the severity of conditions and age-related factors are variable, perhaps because of methodological inconsistencies between studies; and (4) there is a marked lack of longitudinal research examining the natural course of health conditions in people aging with PPS. CONCLUSIONS Longitudinal research is needed to understand the course of health conditions and the impact of multiple secondary conditions in people aging with PPS. Efforts are also needed to develop and test the efficacy of interventions to prevent these secondary health conditions or reduce their negative impact.
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Bang H, Suh JH, Lee SY, Kim K, Yang EJ, Jung SH, Jang SN, Han SJ, Kim WH, Oh MG, Kim JH, Lee SG, Lim JY. Post-polio syndrome and risk factors in korean polio survivors: a baseline survey by telephone interview. Ann Rehabil Med 2014; 38:637-47. [PMID: 25379493 PMCID: PMC4221392 DOI: 10.5535/arm.2014.38.5.637] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Accepted: 07/09/2014] [Indexed: 12/03/2022] Open
Abstract
Objective To obtain information on the socioeconomic, medical, and functional status of polio survivors, and to use these results as the preliminary data for establishing the middle-aged cohort of polio survivors. Methods The subjects were recruited based on the medical records of multiple hospitals and centers. They were assessed through a structured questionnaire over the phone. Post-poliomyelitis syndrome (PPS) was identified according to the specified diagnostic criteria. Differences between polio survivors with or without PPS were evaluated, and the risk factors for PPS were analyzed by the odds ratio (OR). Results Majority of polio survivors were middle-aged and mean age was 51.2±8.3 years. A total of 188 out of 313 polio survivors met the adopted criteria for PPS based on the symptoms, yielding a prevalence of 61.6%. Mean interval between acute poliomyelitis and the development of PPS was 38.5±11.6 years. Female gender (OR 1.82; confidence interval [CI] 1.09-3.06), the age at onset of poliomyelitis (OR 1.75; CI 1.05-2.94), the use of orthoses or walking aids (OR 2.46; CI 1.44-4.20), and the history of medical treatment for paralysis, pain or gait disturbance (OR 2.62; CI 1.52-4.51) represented independent risk factors for PPS. Conclusion We found that the majority of Korean polio survivors entered middle age with many medical, functional, and social problems. Female gender, early age of onset of poliomyelitis, the use of orthoses or walking aids, and the history of medical treatment for paralysis, pain or gait disturbance were identified as the significant risk factors for PPS. A comprehensive and multidisciplinary plan should be prepared to manage polio survivors considering their need for health care services and the risk factors for late effects, such as PPS.
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Affiliation(s)
- Hyun Bang
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Jee Hyun Suh
- Department of Rehabilitation Medicine, Ewha Womans University Medical Center, Seoul, Korea
| | - Seung Yeol Lee
- Department of Physical Medicine and Rehabilitation, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Keewon Kim
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Eun Joo Yang
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Se Hee Jung
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Soong-Nang Jang
- Red Cross College of Nursing, Chung-Ang University, Seoul, Korea
| | - Soo Jeong Han
- Department of Rehabilitation Medicine, Ewha Womans University Medical Center, Seoul, Korea
| | - Wan-Ho Kim
- Department of Rehabilitation Medicine, National Rehabilitation Center, Seoul, Korea
| | - Min-Gyun Oh
- Department of Rehabilitation Medicine and Institute of Health Science, Gyeongsang National University College of Medicine, Jinju, Korea
| | - Jeong-Hwan Kim
- Department of Rehabilitation Medicine, National Rehabilitation Center, Seoul, Korea
| | - Sam-Gyu Lee
- Department of Physical Medicine and Rehabilitation, Research Institute of Medical Sciences, Chonnam National University College of Medical School, Gwangju, Korea
| | - Jae-Young Lim
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul, Korea
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Cooper M, Bigby C. Cycles of adaptive strategies over the life course. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2014; 57:421-437. [PMID: 24372445 DOI: 10.1080/01634372.2013.875972] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
An increasing number of Australia's ageing population are aging with long-term physical impairments. This study explored the life experiences of this group using a qualitative approach. In-depth interviews were conducted with 10 disabled Victorians, aged between 51 and 84 years, and an inductive thematic analysis undertaken. A relationship was found between the adaptive strategies that participants developed as they moved through life phases and the impairment stages. The implications of the emergence of a cyclical process of adaptation across the life course. and particularly in respect of aging, delivery of aged-care services and social workers in this sector are discussed.
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Brogårdh C, Lexell J. Falls, Fear of Falling, Self-Reported Impairments, and Walking Limitations in Persons With Late Effects of Polio. PM R 2014; 6:900-7. [DOI: 10.1016/j.pmrj.2014.04.010] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2013] [Revised: 04/15/2014] [Accepted: 04/19/2014] [Indexed: 11/15/2022]
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Chang KH, Lai CH, Chen SC, Tang IN, Hsiao WT, Liou TH, Lee CM. Femoral neck bone mineral density in ambulatory men with poliomyelitis. Osteoporos Int 2011; 22:195-200. [PMID: 20309527 DOI: 10.1007/s00198-010-1198-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2009] [Accepted: 02/03/2010] [Indexed: 12/20/2022]
Abstract
UNLABELLED We evaluated bilateral femoral neck bone mineral densities (FNBMDs) in 32 men with poliomyelitis and their matched controls. Men with poliomyelitis had significantly lower FNBMD in both legs, and FNBMD was lowest in their shorter legs. Knee extensor strength and regular exercise were important predictive factors associated with decreased FNBMD. INTRODUCTION People with poliomyelitis (polio) are prone to leg fractures after mild trauma. The flaccid paralysis, asymmetric involvement, and underdeveloped growth of afflicted legs may lead to osteoporosis of either leg, characterized by different patterns. This study aimed to measure their femoral FNBMD and to explore the factors associated with changes in FNBMD in either leg. METHODS We did a prospective study to evaluate bilateral FNBMD with dual-energy X-ray absorptiometry in 32 men with polio (age range, 41-57 years; mean, 47 years) and 32 age- and body mass index-matched controls. Measuring the difference in leg length, we classified the legs of each polio subject as "longer" or "shorter." In addition, we chose the right leg of each control as a reference leg. We then used the Mann-Whitney U test to compare FNBMD of these three groups of legs and searched for the factors associated with FNBMD using stepwise multiple regression analyses. RESULTS Compared to the reference leg, men with polio had significantly lower FNBMD in both their longer and shorter legs, by 13% and 23%, respectively. The difference in FNBMD between the two legs of polio subjects was significant. Knee extensor strength and regular exercise were two important factors associated with bilateral FNBMD in men with polio. CONCLUSIONS Men with polio had lower bilateral FNBMD. FNBMD of the shorter leg should be the choice for predicting the risk of hip fracture in men with polio because on average, the shorter leg has lower BMD.
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Affiliation(s)
- K-H Chang
- Department of Physical Medicine and Rehabilitation, Taipei Medical University-Wan Fang Medical Center, Taipei, Taiwan
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Alvarez A, Kremer R, Weiss DR, Benedetti A, Haziza M, Trojan DA. Response of Postpoliomyelitis Patients to Bisphosphonate Treatment. PM R 2010; 2:1094-103. [DOI: 10.1016/j.pmrj.2010.08.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2010] [Revised: 07/29/2010] [Accepted: 08/26/2010] [Indexed: 11/26/2022]
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Abstract
Convincing evidence has accumulated of regulation of bone by the central nervous system. The neural connection between brain and bone is mediated centrally by classic neurotransmitters and several neuropeptides, and peripherally by many of the same neurotransmitters and neuropeptides, albeit with actions opposite to their central effects. Pharmacologic blockade of ß2-adrenergic receptors or disruption of the gene encoding them increases bone mass, whereas increased activity of the sympathetic nervous system (SNS) contributes to bone loss. Brainstem serotonergic neurons regulate SNS activity and its modulation by leptin. Physiologic stimulation of osteoblastic nicotinic receptors results in proliferation and deposition of bone, whereas higher levels inhibit osteoblast function. Activation of sensory nerves has a centrally mediated action on bone, albeit poorly understood. The relative importance of, and interactions between autonomic, sensory, and peripheral nervous system actions on bone mass are also not clear in healthy individuals, and less so in pathologic states.
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Affiliation(s)
- Weiping Qin
- Center of Excellence for the Medical Consequences of Spinal Cord Injury, Bronx, NY 10468, USA.
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Chang JJHT, Fan JCH, Lam HY, Cheung KY, Chu VWS, Fung KY. Treatment of an osteoporotic Hoffa fracture. Knee Surg Sports Traumatol Arthrosc 2010; 18:784-6. [PMID: 19890627 DOI: 10.1007/s00167-009-0960-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2009] [Accepted: 10/05/2009] [Indexed: 11/29/2022]
Abstract
Two patients with Hoffa fracture of the knee, both suffering from poliomyelitis are reported. Both had unicondylar coronal plane fracture of the medial femoral condyle. The patients were treated with open reduction and screw fixation. Due to poor screw purchase, reoperation was necessary in one patient. The results were satisfactory in both patients.
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Affiliation(s)
- Joseph Jeremy Hsi Tse Chang
- Department of Orthopaedics and Traumatology, Alice Ho Miu Ling Nethersole Hospital, Tai Po, Hong Kong, China
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Laffont I, Julia M, Tiffreau V, Yelnik A, Herisson C, Pelissier J. Aging and sequelae of poliomyelitis. Ann Phys Rehabil Med 2010; 53:24-33. [DOI: 10.1016/j.rehab.2009.10.002] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2009] [Accepted: 10/09/2009] [Indexed: 01/24/2023]
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