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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

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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 (Tult) and stiffness were calculated at the proximal tibia and distal femur.

Results

Tult 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). Tult 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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Data availability

Public clinical trial registration: http://clinicaltrials.gov/show/NCT01426555. FES-Rowing Versus Zoledronic Acid to Improve Bone Health in Spinal Cord Injury (SCI).

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Funding

This study received support from the Department of Defense (W81XWH-10-1-1043 to LRM).

Author information

Authors and Affiliations

  1. Department of Mechanical Engineering, Northern Arizona University, Flagstaff, AZ, USA

    Y. Fang

  2. Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, MN, USA

    L.R. Morse, N. Nguyen & R.A. Battaglino

  3. Spaulding Rehabilitation Hospital, Department of Physical Medicine and Rehabilitation, Harvard Medical School, Cambridge, MA, USA

    R.F. Goldstein

  4. Department of Biomedical Engineering, Worcester Polytechnic Institute, Worcester, MA, USA

    K.L. Troy

Authors
  1. Y. Fang
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  2. L.R. Morse
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  4. R.A. Battaglino
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  6. K.L. Troy
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Contributions

Parent study conceived by LRM and RAB. Analysis conceived by KLT and LRM. Analysis performed by YF, with contributions from NN and RFG. Data interpretation by LRM, RAB, and KLT. Manuscript drafted by YF and KLT with input from all authors.

Corresponding author

Correspondence to K.L. Troy.

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The present study was a secondary analysis that utilized deidentified data only. It did not require institutional approval. The parent study was institutionally approved, and all participants gave written informed consent prior to participation.

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Fang, Y., Morse, L., Nguyen, N. et al. 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. Osteoporos Int 32, 549–558 (2021). https://doi.org/10.1007/s00198-020-05610-x

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