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. 2017 Jul;28(7):2177-2186.
doi: 10.1007/s00198-017-4018-z. Epub 2017 Apr 1.

Acute bone changes after lower limb amputation resulting from traumatic injury

D A Bemben  1 , V D Sherk  2 , W J J Ertl  3 , M G Bemben  4
Affiliations

Acute bone changes after lower limb amputation resulting from traumatic injury

D A Bemben et al. Osteoporos Int. 2017 Jul.

Abstract

Bone health is critical for lower limb amputees, affecting their ability to use a prosthesis and their risk of osteoporosis. We found large losses in hip bone mineral density (BMD) and in amputated bone strength in the first year of prosthesis use, suggesting a need for load bearing interventions early post-amputation.

Introduction: Large deficits in hip areal BMD (aBMD) and residual limb volumetric BMD (vBMD) occur after lower limb amputation; however, the time course of these bone quality changes is unknown. The purpose of this study was to quantify changes in the amputated bone that occur during the early stages post-amputation.

Methods: Eight traumatic unilateral amputees (23-53 years) were enrolled prior to surgery. Changes in total body, hip, and spine aBMD (dual-energy X-ray absorptiometry); in vBMD, stress-strain index (SSI), and muscle cross-sectional area (MCSA) (peripheral QCT); and in bone turnover markers were assessed after amputation prior to prosthesis fitting (pre-ambulatory) and at 6 and 12 months walking with prosthesis.

Results: Hip aBMD of the amputated limb decreased 11-15%, which persisted through 12 months. The amputated bone had decreases (p < 0.01) in BMC (-26%), vBMD (-21%), and SSI (-25%) from pre-ambulatory to 6 months on a prosthesis, which was maintained between 6 and 12 months. There was a decrease (p < 0.05) in the proportion of bone >650 mg/cm3 (58 to 43% of total area) or >480 mg/cm3 (65% to 53%), suggesting an increase in cortical porosity after amputation. Bone alkaline phosphatase and sclerostin were elevated (p < 0.05) at pre-ambulatory and then decreased towards baseline. Bone resorption markers were highest at surgery and pre-ambulatory and then progressively decreased (p < 0.05).

Conclusions: Rapid and substantial losses in bone content and strength occur early after amputation and are not regained by 12 months of becoming ambulatory. Early post-amputation may be the most critical window for preventing bone loss.

Keywords: Bone density; Bone geometry; Bone remodeling; Prosthesis; Trauma.

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