Published online Oct 18, 2020. doi: 10.5312/wjo.v11.i10.453
Peer-review started: June 2, 2020
First decision: July 4, 2020
Revised: July 15, 2020
Accepted: September 10, 2020
Article in press: September 10, 2020
Published online: October 18, 2020
Processing time: 137 Days and 22.4 Hours
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.
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.
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.
Core Tip: The long-term effects of intrathecal baclofen treatment (IBT) on bone mineral density and body composition profile were investigated in a man with spinal cord injury compared to two matched participants with different age and time since injury. Bone mineral density loss was greater at the distal femur and proximal tibia compared to the matches without IBT. Furthermore, the case had greater percentage leg fat mass and lower percentage lean mass compared to both matches. The negative side effects of IBT implantation warrant further studies considering the prevalence of osteoporosis related fractures, cardiovascular diseases, and metabolic disorders in this population.