Abstract
Spinal cord injuries (SCIs) represent a variety of conditions related to the damage of the spinal cord with consequent musculoskeletal repercussions. The bone and muscle tissues share several catabolic pathways that lead to variable degrees of disability in SCI patients. In this review article, we provide a comprehensive characterization of the available treatment options targeting the skeleton and the bone in the setting of SCI. Among the pharmacological intervention, bisphosphonates, anti-sclerostin monoclonal antibodies, hydrogen sulfide, parathyroid hormone, and RANKL pathway inhibitors represent valuable options for treating bone alterations. Loss phenomena at the level of the muscle can be counteracted with testosterone, anabolic-androgenic steroids, and selective androgen receptor modulators. Exercise and physical therapy are valuable strategies to increase bone and muscle mass. Nutritional interventions could enhance SCI treatment, particularly in the setting of synergistic and multidisciplinary interventions, but there are no specific guidelines available to date. The development of multidisciplinary recommendations is required for a proper clinical management of SCI patients.
Highlights
Spinal cord injuries (SCIs) encompass a spectrum of conditions associated with modifications in the function of both central and peripheral nervous systems
Given that an increased ROS production is one of the main mechanisms related to bone and muscle modifications after SCI, all these results suggest a potential role of H2S treatment in SCI-related bone loss
Lambach et al [62] performed a study on four adults with recent (
Summary
Spinal cord injuries (SCIs) encompass a spectrum of conditions associated with modifications in the function of both central and peripheral nervous systems. These patients experience important changes in the bones (e.g., osteoporosis) that cause a significantly increased risk of fractures, even after minor traumas (e.g., transferring or sitting) [2, 3] These clinical conditions lead to further immobilization of the patient, increased spasticity, pressure ulcers, and in general worsened disability [3]. Despite muscle atrophy is macroscopically more evident than osteoporosis, this phenomenon is often underestimated [7] In this scenario, understanding the biological interplay of the bone and muscle tissues is crucial for proper clinical management of SCIs. Here, we sought to provide a comprehensive portrait of the potentials and limitations of the various treatment options available (or proposed) to date for both osteoporosis and muscle atrophy occurring after SCIs
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