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Osteoporosis International

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01-03-2021 | Zoledronic Acid | Original Article

Functional electrical stimulation (FES)–assisted rowing combined with zoledronic acid, but not alone, preserves distal femur strength and stiffness in people with chronic spinal cord injury

Authors: Y. Fang, L.R. Morse, N. Nguyen, R.A. Battaglino, R.F. Goldstein, K.L. Troy

Published in: Osteoporosis International | Issue 3/2021

Abstract

Summary

We investigated the effect of 12 months of functional electrical stimulation–assisted rowing with and without zoledronic acid (ZA) on computationally estimated bone strength and stiffness in individuals with spinal cord injury. We found that rowing with ZA, but not rowing alone, improved stiffness at the distal femur, but not the proximal tibia.

Introduction

People with spinal cord injury (SCI) have high fracture risk at the knee after the injury. Therapies that prevent bone loss or stimulate an anabolic response in bone have been proposed to reduce fractures. Zoledronic acid (ZA) is a potent bisphosphonate that inhibits osteoclastic resorption. Functional electrical stimulation (FES)–assisted rowing is a potentially osteogenic exercise involving mechanical stimulation to the lower extremities. Here, we investigated the effect of FES-assisted rowing with and without ZA on bone strength and stiffness in individuals with SCI.

Methods

Twenty individuals from a cohort of adults with SCI who participated in a clinical trial were included in the study. CT scans of their knees before and after the intervention were converted to finite element models. Bone failure strength (T_ult) and stiffness were calculated at the proximal tibia and distal femur.

Results

T_ult at the distal femur increased 4.6% among people who received rowing + ZA and decreased 13.9% among those with rowing only (p < 0.05 for group). Torsional and compressive stiffness at the femur metaphysis increased in people with rowing + ZA (+ 3 to +4%) and decreased in people with rowing only (− 7 to −8%; p < 0.05). T_ult in the proximal tibia decreased in everyone, but the loss was attenuated in the rowing + ZA group. People with initially stronger bone tended to lose more strength.

Conclusion

Overall, we observed increases in bone strength at the distal femur but not the proximal tibia, with FES–assisted rowing combined with ZA treatment. Rowing alone did not significantly prevent bone loss at either site, which might be attributed to insufficient mechanical loading.

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Title: Functional electrical stimulation (FES)–assisted rowing combined with zoledronic acid, but not alone, preserves distal femur strength and stiffness in people with chronic spinal cord injury
Authors: Y. Fang
L.R. Morse
N. Nguyen
R.A. Battaglino
R.F. Goldstein
K.L. Troy
Publication date: 01-03-2021
Publisher: Springer London
Keyword: Zoledronic Acid
Published in: Osteoporosis International / Issue 3/2021
Print ISSN: 0937-941X
Electronic ISSN: 1433-2965
DOI: https://doi.org/10.1007/s00198-020-05610-x

At a glance: The STEP trials

Springer Medicine

Functional electrical stimulation (FES)–assisted rowing combined with zoledronic acid, but not alone, preserves distal femur strength and stiffness in people with chronic spinal cord injury

Abstract

Summary

Introduction

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Summary

Introduction

Methods

Results

Conclusion

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