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Low Bone Mineral Density and Fragility Fractures in Permanent Vegetative State Patients
Author(s) -
Oppl Bastian,
Michitsch Gabriele,
Misof Barbara,
Kudlacek Stefan,
Donis Johann,
Klaushofer Klaus,
Zwerina Jochen,
Zwettler Elisabeth
Publication year - 2014
Publication title -
journal of bone and mineral research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.882
H-Index - 241
eISSN - 1523-4681
pISSN - 0884-0431
DOI - 10.1002/jbmr.2122
Subject(s) - bone mineral , fragility , medicine , dentistry , orthodontics , osteoporosis , chemistry
ABSTRACT Disuse of the musculoskeletal system causes bone loss. Whether patients in vegetative state, a dramatic example of immobilization after severe brain injury, suffer from bone loss and fractures is currently unknown. Serum markers of bone turnover, bone mineral density (BMD) measurements, and clinical data were cross‐sectionally analyzed in 30 consecutive vegetative state patients of a dedicated apallic care unit between 2003 and 2007 and compared with age‐ and sex‐matched healthy individuals. Vegetative state patients showed low calcium levels and vitamin D deficiency compared with healthy controls. Serum bone turnover markers revealed high turnover as evidenced by markedly elevated carboxy‐terminal telopeptide of type I collagen (β‐crosslaps) and increased levels of alkaline phosphatase. BMD measured by dual‐energy X‐ray absorptiometry (DXA) scanning showed strongly decreased T ‐ and Z ‐scores for hip and spine. Over a period of 5 years, 8 fragility fractures occurred at peripheral sites in 6 of 30 patients ( n = 3 femur, n = 2 tibia, n = 2 fibula, n = 1 humerus). In conclusion, high bone turnover and low BMD is highly prevalent in vegetative state patients, translating into a clinically relevant problem as shown by fragility fractures in 20% of patients over a time period of 5 years. © 2014 American Society for Bone and Mineral Research.