Association Between Combat-Related Traumatic Injury and Skeletal Health: Bone Mineral Density Loss is Localised and Correlates with Altered Loading in Amputees - The ADVANCE Study

Description

In a presentation delivered by David Cain, a Military CT2 at the Royal Shrewsbury Hospital, the topic of study focused on bone mineral density in amputees. Cain introduces osteoporosis, a condition typically affecting older individuals characterized by low bone mineral density and changes in bone microarchitecture. He emphasizes that this condition can also stem from factors such as reduced bone loading and systemic inflammation, particularly relevant in cases of combat-related traumatic injuries leading to amputation.



Cain presents alarming statistics, noting that over half of military amputees are diagnosed with osteopenia or osteoporosis. Current treatments often include hormone replacement therapy or bisphosphonates, which carry systemic side effects, particularly problematic for younger patients who may require long-term use.



The ADVANCE cohort study undertaken aimed to assess the bone mineral density of the lumbar spine and neck of femur among 579 combat-related trauma patients, including 153 amputees, in comparison to 562 matched controls. The methodology involved statistical analyses, with DXA scanning employed to measure bone mineral density.



Cain shares the study results, highlighting that injured individuals exhibited no significant difference in lumbar spine T scores, but revealed significantly lower bone mineral density in the neck of femur compared to controls. Subsequent subgroup analyses reinforced the hypothesis that post-amputation, reduced mechanical loading—especially in above-knee amputees—led to a decrease in bone density.



The findings indicate that while global activity levels did not significantly vary, localized loading changes post-amputation contributed to reduced bone mineral density, suggesting a form of disuse osteopenia specific to amputees. Cain advocates for this new diagnostic term to better differentiate between traditional osteoporosis and post-amputation bone density loss, aiming to refine treatment approaches and foster improvements in prosthetic design to mitigate such changes.



The presentation concludes with a call for further research into the ideal loading environments for prosthetics, and the audience responds with applause.

Specialties