Long-term effect of intrathecal baclofen treatment on bone health and body composition after spinal cord injury: A case matched report

Dora E Ifon, Mina P Ghatas, John C Davis, Refka E Khalil, Robert A Adler, Ashraf S Gorgey, Dora E Ifon, Mina P Ghatas, John C Davis, Refka E Khalil, Robert A Adler, Ashraf S Gorgey

Abstract

Background: Severe spasticity may negatively impact functionality and quality of life after spinal cord injury (SCI). Intrathecal baclofen treatment (IBT) is effectively used to manage severe spasticity and reduce comorbidities. However, long-term IBT may have a negative effect on bone mineral content (BMC), bone mineral density (BMD) and body composition (such as percentage fat mass and lean body mass). We demonstrated the negative effects of long-term IBT use in a single case compared with two non-IBT users.

Case summary: A 46-year old Caucasian male Veteran (case) with a 21 year history of complete tetraplegia (complete C6 SCI) was implanted with IBT for 20 years. The case was matched to two participants with different time since injuries [2 (match 1) and 13 (match 2) years] without IBT. Knee BMC and BMD at the epiphysis and metaphysis of the distal femur and proximal tibia were evaluated using dual knee and the dual femur modules of GE Lunar iDXA software. Total and leg body composition assessments were also conducted for the three participants. Potential effect of long-term IBT was demonstrated by changes in BMD, consistent with bone demineralization, at the distal femur and proximal tibia and changes in percentage fat mass and lean mass of legs. The case showed 113% lower BMD at the distal femur, and 78.1% lower at the proximal tibia compared to match 1, moreover the case showed 45% lower BMD at the distal femur, and no observed changes at the proximal tibia compared to match 2. The case had 27.1% and 16.5% greater leg %fat mass compared to match 1 and match 2, respectively. Furthermore, the case had 17.4% and 11.8% lower % leg lean mass compared to match 1 and match 2, respectively.

Conclusion: Long-term IBT may impact bone health and body composition parameters in persons with complete SCI. It may be prudent to encourage regular screening of individuals on long-term IBT considering the prevalence of osteoporosis related fractures, cardiovascular diseases, and metabolic disorders in this population.

Keywords: Bone mineral density; Case report; Epiphysis; Intrathecal baclofen; Metaphysis; Spasticity; Spinal cord injury.

Conflict of interest statement

Conflict-of-interest statement: No conflict of interest.

©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.

Figures

Figure 1
Figure 1
Regional left knee scan for case using GE software (Encore v.16). A: Initially detected knee (un-brushed) with many un-assigned bone pixels; B: Corrected (brushed) image of the knee scan with four regions of interest. DFM: Distal femur metaphysis; DFE: Distal femur epiphysis; PTE: Proximal tibia epiphysis; PTM: Proximal tibia metaphysis.
Figure 2
Figure 2
Bar plots for bone mineral density (g/cm2) and bone mineral content (g) values of distal femur for the case and matched participants. A: Left distal femur metaphysis [Bone mineral density (BMD)]; B: Right distal femur metaphysis (BMD); C: Left distal femur metaphysis [Bone mineral content (BMC)]; D: Right distal femur metaphysis (BMC); E: Left distal femur epiphysis (BMD); F: Right distal femur epiphysis (BMD); G: Left distal femur epiphysis (BMC); H: Right distal femur epiphysis (BMC). BMC: Bone mineral content; BMD: Bone mineral density.
Figure 3
Figure 3
Bar plots for bone mineral density (g/cm2) and bone mineral content (g) values of proximal tibia for the case and matched participants. A: Left proximal tibia metaphysis [Bone mineral density (BMD)]; B: Right proximal tibia metaphysis (BMD); C: Left proximal tibia metaphysis [Bone mineral content (BMC)]; D: Right proximal tibia metaphysis (BMC); E: Left proximal tibia epiphysis (BMD); F: Right proximal tibia epiphysis (BMD); G: Left proximal tibia epiphysis (BMC); H: Right proximal tibia epiphysis (BMC). BMC: Bone mineral content; BMD: Bone mineral density.
Figure 4
Figure 4
Bar plot for total body and leg composition for the case and matched participants. A: Leg bone mineral content (BMC) (g); B: Total body BMC (g); C: Leg lean mass (g); D: Total body lean mass (g); E: Percentage leg fat mass; F: Percentage total body fat mass.

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