Statin Therapy as Potential Treatment for Endocrine Metabolic Disease in Individuals with Chronic Spinal Cord Injury: A Cross-Sectional Study
1Miyatani M, 1Alavinia S, 2Giangregorio L, 1Blencowe L, 3Anderson-Erisman K, 4Cheung A, 3Nash M, 1Craven B
1Toronto Rehabilitation Institute-UHN, Toronto, Ontario, Canada; 2University of Waterloo, Waterloo, Ontario, Canada; 3University of Miami Miller School of Medicine, Miami, Florida, USA; 4Departments of Medicine and Joint Department of Medical Imaging, University Health Network, Toronto, Ontario, Canada
Objective: Endocrine metabolic disease (EMD) including sarcopenic obesity, abdominal obesity, osteoporosis, fracture, diabetes and heart disease are common established complications of spinal cord injury (SCI).
The 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors (statins) are widely used for treatment of hyperlipidemia. Uzzan’s 2007 meta-analyses concluded statins are osteoprotective (general population).
The objectives are 1) to describe the prevalence of sarcopenia, sarcopenic obesity, and abdominal obesity, low bone mass and prior history of fracture in adults with chronic motor-complete SCI; and, 2) to describe differences in lower extremity, hip and knee region bone mineral density (BMD) among individuals with chronic SCI who are statin users vs. non-users.
Design/Methods: Adults with SCI (18–60 yrs, duration of injury ≥2 years, NLI between C1-T10, AIS A-B) consented to study participation. Participants had dual-energy X-ray absorptiometry (DXA) scans of the whole body, total hip, distal femur and proximal tibia analyzed for visceral adipose tissue area (VAT), appendicular lean mass index (ALMI) and regional BMD (total hip, distal femur and proximal tibia). Abdominal obesity was defined by ≥VAT 100cm2. Sarcopenia was defined by ALMI (men, ≤7.26kg/m2; women, ≤5.5kg/m2). Sarcopenic obesity was defined by the presence of both abdominal obesity and sarcopenia. Low bone mass was defined by a Z-score ≤ -3.0 of the total hip, distal femur and/or proximal tibia, or prior fracture. Bisphosphonate and statin exposure were obtained via chart abstraction. Independent t-tests were used to compare the two groups for normally distributed variables; otherwise the Mann-Whitney U test was used.
Forty-one adults participants (n=28 men, n=13 women) met study inclusion criteria (mean±SD age 45 ±10 yr). Thirty-nine participants completed whole body DXA scans, 36 completed total hip + knee region DXA scans, and 34/41 had both scans completed. Chart reviews identified 5 statin and 27 bisphosphonate users. Prevalence of abdominal obesity, sarcopenia, sarcopenic obesity and low bone mass was 74.3 %, 65.3%, 53.9 % and 100 %, respectively. A majority (52.9%) of participants had both sarcopenic obesity and low bone mass.
Statin users (n=5) were older than non-statin users (n=31) [53.7±14.2 vs 44.8±9.4 yr, p = 0.1]. Statin users and non-statin users had a similar duration of injury and bisphosphonate exposure. When comparing statin users with non-statin users, users had higher BMD at hip (6%: 0.674 ± 0.241 g/cm2 vs. 0.632 ± 0.150 g/cm2, p = 0.59), distal femur (8.2%: 0.491 ± 0.124 g/cm2 vs. 0.533 ±0.179 g/cm2, p = 0.52) and proximal tibia (9%: 0.403±0.100 g/cm2 vs. 0.428±0.102 g/cm2 , p = 0.60).
Conclusions: A majority (>50%) of the cohort had sarcopenic obesity and all participants had low bone mass implying the need for EMD risk stratification tools. These descriptive analyses support the need to confirm if statins are an effective therapy to increase hip/knee region BMD among individuals with chronic motor complete SCI and both sarcopenic obesity and lower bone mass at baseline.
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