Method: The subjects were included 26 patients with spinal cord injury and 22 healthy men. We measured serum osteocalcin and urine deoxypyridinoline (DPYD) in 2 hours after awakening and measured BMDs in lumbar vertebrae, femur, and distal forearm in patients and control group. The patients were 21 men, 5 women, mean age 43.2⁑14.3 years, and mean duration 28.3⁑45.0 months, who were divided by injury level and injury severity respectively.

Results: The biochemical markers of bone metabolism in patients group had significant differences comparing to control group (p＜0.05). The urine DPYD and BMDs in femur showed significantly negative correlation with the duration of spinal cord injury (p＜0.05).

Conclusion: In patients with spinal cord injury, urine DPYD and BMDs in femur had significant correlation with the duration of injury. But, the injury level and injury severity had no significant correlation with the markers of bone metabolism and BMDs. (J Korean Acad Rehab Med 2003; 27: 894-898)

Objective: The purpose of this study is to find out what is the effect of epidural corticosteroid injection on bone metabolism.

Method: We have assessed the systemic effects of a single epidural triamcinolone acetonide injection on biochemical indices of bone formation and resorption in patients with lumbosacral radiculopathy. Twenty patients who had lumbosacral radiculopathy and free from exposure to corticosteroid for at least 6 weeks were selected for this study. Patients were classifed as two groups; 1) epidural block with 2% lidocaine 3 ml and 0.9% normal saline 15 ml (4 men, 5 women; mean age 47.2⁑7.6 years) and 2) combination of triamcinolone acetonide 40 mg (5 men, 6 women; mean age 49.6⁑8.2 years). Fasting serum and the second voided urine were collected at 0, 1, 3, 7 and 14 days after the single epidural injection for bone-related biochemical

markers measurements.

Results: 1) Level of serum osteocalcin showed a significant time trend in the epidural corticosteroid injection group. Osteocalcin decreased dramatically from 11.2⁑3.4 ng/ml on day 0 to 5.9⁑2.8 ng/ml on day 1, 6.1⁑1.5 ng/ml on day 3 (p＜0.05). After the initial drop, the level recovered to 9.8⁑3.7 ng/ml by day 7, and returned to preinjection level on day 14, at 10.9⁑4.1. 2) Urinary deoxypyridinoline levels did not show any significant changes.

Conclusion: According to the above results, the epidural injection of corticosteroid may be a better therapeutic mode, with less potential for harmful effects to bone metabolism, in providing effective relief of symptoms to patients with lumbosacral radiculopaties. (J Korean Acad Rehab Med 2002; 26: 203-207)

Objective: To assess change of bone metabolism in hemiplegic patients after stroke.

Method: Sera were collected from 19 hemiplegic patients after stroke. Sera were assayed for 25-hydroxyvitamin D (25-OHD), 1,25-dihydroxyvitamin D (1,25-(OH)2D), parathyroid hormone (PTH), calcium and osteocalcin.

Results: Serum 25-OHD and 1,25-(OH)2D concentration were 15.13 mg/mL and 20.88 pg/mL, respectively. Serum PTH was 47.23 pg/mL. In 5 (26%) of the patients, the serum 25-OHD concentration were ＜10 ng/mL (deficient level). Ten (52%) of the patients had vitamin D concentrations between 10 and 20 ng/mL (insufficient level). The mean PTH concentration was not significantly higher in patients with deficient levels of 25-OHD (61.80 pg/mL) than those with insufficient (43.63 pg/mL) or sufficient (38.05 pg/mL) levels of 25-OHD. Serum 25-OHD concentration were lower in the late group (11.11 mg/mL) than in the early group (18.05 mg/mL), whereas serum PTH concentration were higher in the late group (58.96 pg/mL) than in the early group (38.70 pg/mL).

Conclusion: Compensatory hyperparathyroidism with hypovitaminosis D occurred in the hemiplgic patients after stroke, especially more than one year from onset.

Spinal cord injury causes a decrease in bone mass, an osteopenia and an increased risk of fractures. In this condition, previous histomorphologic and biochemical reports have shown an uncoupling between bone formations and resorptions, however the exact sequence of events resulting in bone loss is still not fully understood. Since accurate and sensitive techniques have become available recently to assess bone metabolism, more informations are now available regarding the bone loss in paralysed or immobilized individuals. The purpose of this study is to clarify the changes of biochemical markers and bone densities. Ten complete and 10 incomplete spinal cord injury patients were enrolled for this study. The bone density of femur and lumbar vertebra, and the biochemical markers such as serum osteocalcin and urine deoxypyridinoline were measured. Results were analyzed by Mann-Whitney method and Pearson's correlation of SPSS PC program.

Comparing with normal values, in the spinal cord injury groups, the values of serum osteocalcin were elevated(p＞0.05), and also the values of urine deoxypyridinoline were significantly elevated(p＜0.05). The duration after spinal cord injury and the bone density of femur and lumbar vertebra showed a moderate negative correlation(Pearson's R: ⁣0.47, ⁣0.43, respectively)(p＜0.05).

In conclusion, the results of increased values of biochemical markers in bone metabolism support that the bone turn-over rate increases after the spinal cord injury.