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PubMed2004

Adaptive filtering for ECG rejection from surface EMG recordings.

Surface electromyograms (EMG) of back muscles are often corrupted by electrocardiogram (ECG) signals. This noise in the EMG signals does not allow to appreciate correctly the spectral content of the EMG signals and to follow its evolution during, for example, a fatigue process. Several methods have been proposed to reject the ECG noise from EMG recordings, but seldom taking into account the eventual changes in ECG characteristics during the experiment. In this paper we propose an adaptive filtering algorithm specifically developed for the rejection of the electrocardiogram corrupting surface electromyograms (SEMG). The first step of the study was to choose the ECG electrode position in order to record the ECG with a shape similar to that found in the noised SEMGs. Then, the efficiency of different algorithms were tested on 28 erector spinae SEMG recordings. The best algorithm belongs to the fast recursive least square family (FRLS). More precisely, the best results were obtained with the simplified formulation of a FRLS algorithm. As an application of the adaptive filtering, the paper compares the evolutions of spectral parameters of noised or denoised (after adaptive filtering) surface EMGs recorded on erector spinae muscles during a trunk extension. The fatigue test was analyzed on 16 EMG recordings. After adaptive filtering, mean initial values of energy and of mean power frequency (MPF) were significantly lower and higher respectively. The differences corresponded to the removal of the ECG components. Furthermore, classical fatigue criteria (increase in energy and decrease in MPF values over time during the fatigue test) were better observed on the denoised EMGs. The mean values of the slopes of the energy-time and MPF-time linear relationships differed significantly when established before and after adaptive filtering. These results account for the efficacy of the adaptive filtering method proposed here to denoise electrophysiological signals.

Algorithms↗
PubMed2004

The influence of slouching and lumbar support on iliolumbar ligaments, intervertebral discs and sacroiliac joints.

OBJECTIVE: To investigate lumbopelvic kinematics when moving into a slouch. DESIGN: A biomechanical model was developed. Load tests in vitro verified the model. BACKGROUND: The precise mechanism causing disc herniation and back sprain is still debated. Most biomechanical studies have focused on lifting in a stooped posture. Previous studies address instability situations due to Euler buckling of the spine under axial load. However, no studies address lumbosacral, iliolumbar and sacroiliac kinematics in slouching, i.e. flexing the spine in situations with negligible compressive spinal load. METHODS: Modeling started with the click-clack movement, i.e. the transition from lumbar lordosis to lumbar kyphosis by the combination of backward rotation of the pelvis and ventral flexion of the spine. The flexed spine was compared with a crowbar which uses the iliolumbar ligaments as fulcrum and pivot. To analyse the click-clack movement in sitting, unembalmed erect human trunks were moved from a forward position to a backward position, recording angular changes between L5, sacrum and ilium. RESULTS: When moving the trunk stepwise backward with support at shoulder level, L5 showed forward rotation with respect to the sacrum, but rotation of the sacrum with respect to the iliac bones was reversed (i.e. counternutation). L5 showed displacement in ventral direction with respect to the ilium. Measurements were in agreement with prediction from the crowbar model of the spine. CONCLUSIONS: Backward rotation of the pelvis combined with flexion of the spine, i.e. slouching, results in backward rotation of the sacrum with respect to the ilium, dorsal widening of the intervertebral disc L5-S1 and strain on the iliolumbar ligaments when protection from back muscles against lumbar flexion is absent. Lumbar backrest support almost eliminates lumbosacral and sacroiliac movement. RELEVANCE: Understanding why the iliolumbar ligaments are loaded in slouching contributes to the understanding of the biomechanics of low back pain in everyday situations with small or negligible compressive spinal load. The results recommend lumbar support: backrests with free shoulder space.

Aged↗
PubMed1981

Supraspinal and segmental input to lumbar epaxial motoneurons in the rat.

Inputs to medial longissimus (ML) and lateral longissimus (LL) motoneurons were studied in urethane or urethane-chloralose anesthetized rats by recording from ML and LL nerves while stimulating ipsilateral lumbosacral dorsal roots, medial medullary reticular formation (RF), vestibular nuclei (VN), dorsal midbrain (MDBR), or ventromedial hypothalamus (VMH). Stimulation of appropriate dorsal roots produced short-latency responses (1.5-3.0 ms) in nerves to medial longissimus or lateral longissimus. The connections underlying these responses, which could be monosynaptic, are weak, since generally two or more stimuli were necessary for a response to occur. Short-latency LL nerve responses required more dorsal root stimuli than did ML nerve responses and stable LL responses sometimes could not be obtained, suggesting that segmental reflexes to a back muscle (LL) could be weaker than those to a proximal tail muscle (ML). Trains of conditioning stimuli delivered to the RF, VN, and MDBR facilitated segmental responses in ML nerves or LL nerves. Temporal profiles of facilitation of ML differed for the three regions. On one extreme, the facilitation produced by RF conditioning required few stimuli (median, 3 shocks) and peak facilitation occurred at short condition-test intervals (median, 1.5 ms). On the other extreme, facilitation produced by MDBR conditioning required long trains (median, 14 stimuli) and peak facilitation occurred at longer condition-test intervals (median, 10 ms). Stimulation within the VMH never facilitated ML or LL nerve activity. These results demonstrate excitatory connections from reticular formation, vestibular nuclei and the dorsal midbrain to medial longissimus and lateral longissimus. Such connections could be involved in behaviors mediated by midbrain, and in postural regulation through brain stem control of axial musculature. Motoneuron cell bodies for LL, ML and lumbar transversospinalis (TS) muscles were localized by ejecting dye at sites where unitary antidromic responses to muscle nerve stimulation were recorded extracellularly. ML cells were found ventrolaterally in the L6-S1 ventral horn. LL and TS cells were found medially in the ventral horn of the lumbar enlargement.

Animals↗
PubMed1977

Calcium antagonism of the block in excitation-contraction coupling produced by a urea exposure-removal treatment.

Exposing frog's toe muscles to Ringer's solution made hypertonic with 400 mM urea for 60 min followed by placing the muscles back in Ringer's (urea-removal treatment) completely blocks the twitch without disrupting the surface openings of the T-tubules. The urea-removal treatment also increased the triadic junction width. Placing the muscles in Ringer's with an elevated calcium concentration (5 mM) following exposure to the hyertonic solution prevented the block of the twitch response but not the increase in the triadic junction width. Exposing untreated muscles to Ringer's with 5 mM calcium either had no effect on the twitch on reduced it by 30 percent or less. These results suggest the possibility that increasing the width of the triadic junction decreases the amount of calcium ions reaching the terminal cisternae during an action potential thereby blocking the twitch. Elevating the calcium concentration in the T-tubules would increase the amount of calcium which enters the triadic junction during an action potential and thus antagonize the above effects.

Action Potentials↗
PubMed1987

Electrical stimulation of the midbrain central gray facilitates reticulospinal activation of axial muscle EMG.

EMG responses were recorded from axial muscles transversospinalis, medial longissimus, and lateral longissimus in urethane-anesthetized rats during combined electrical stimulation of the reticular formation and midbrain central gray. Central gray stimulation facilitated reticular formation-evoked EMG activity in the back muscles of the rat. Electrical stimulation of the central gray lowered the threshold for reticulospinal activation of axial muscles and could maintain firing in these muscles after the end of a reticular formation train. Units were recruited in order of size from small to large. In only one case, central gray stimulation activated axial muscles directly without reticular formation stimulation. The central gray may be important in relaying hypothalamic influences to the reticular formation, which has direct access to the axial muscles responsible for lordosis behavior.

Action Potentials↗
PubMed1993

Intensive dynamic back exercises with or without hyperextension in chronic back pain after surgery for lumbar disc protrusion. A clinical trial.

Sixty-two patients with chronic low back pain occurring 14-60 months after undergoing discectomy for the first time were randomized to two physical treatment groups: 24 sessions of intensive dynamic back exercises with hyperextension or 24 sessions of intensive dynamic back exercises without hyperextension. At the conclusion of therapy and at one-year follow-up, no difference was seen between the randomized groups, with regard to the combined assessments of pain, disability and objective measurements. A difference for back exercises without hyperextension to be superior to the other treatment regimen was statistically significant at the three-month follow-up. In the patient's qualitative assessment of treatment outcome there were seen no significant differences between back exercises with or without hyperextension. There was a similar and significant improvement of the isometric endurance of back muscles in both groups, but the flexibility of the spine was significantly improved only in the group using hyperextension exercises. The overall response rate of an earlier published investigation was reproduced. It is concluded that chronic back patients after first time discectomy may benefit from an intensive rehabilitation protocol including intensive exercises. The added use of hyperextension exercises does not confer any independent benefit. Furthermore, the training had to continue for more than 2-3 months before a statistical significant decrease in back pain was reported in the patient pain diary.

Adult↗
PubMed1984

Brain stem reticular influences on lumbar axial muscle activity. II. Temporal aspects.

Epaxial muscle electromyographic (EMG) responses to electrical stimulation of the pontomedullary reticular formation were analyzed for temporal patterns in the urethan-anesthetized rat. Recordings were obtained from the transversospinalis, medial longissimus, and lateral longissimus groups of back muscles. In response to a series of repetitive stimulus trains, the latency of muscle activation decreased with successive trains. Typically a 10-fold decrease in latency required eight to nine stimulus trains (5 trains/s, 25 pulses/train) with currents of 25-30 microA. Individual pulses within long stimulus trains evoked muscle spike potentials at low probability but with short latencies (population range 4-7 ms). The results suggest that whereas influences on lumbar axial musculature from brain stem reticular formation were not powerful enough to evoke muscle spikes with single-pulse stimulation at currents applied in this study, they can yield short, relatively fixed EMG onset latencies in response to individual pulses within stimulus trains once a potentiation phenomenon has occurred.

Animals↗
PubMed2001

Electrophysiological, histological, and behavioral studies in a cat with acute compression of the spinal cord.

We made an animal model of cervical spinal cord injury in a cat and performed electrophysiological, histological, and bechavioral studies. The cervical spinal cord injury model was made by inserting a screw through the fourth cervical vertebral body of the cat. After the injury, muscle tonus of the limbs and trunk diminished. The cat was able to walk and to perform target reaching after the injury, although the trunk was unstable and the movement of the forelimb was ataxic. Atrophy of the back muscle remained. The cat was unable to stand bipedally. These behavioral disturbances suggested dysfunction of the ventral funiculus. After behavioral analysis for 3 months, an electrophysiological study was performed. Action potentials of the ventral funiculus evoked by stimulation of the lateral vestibular nucleus or the medial longitudinal fasciculus were recorded at several levels of the cervical cord. They were diminished at levels caudal to the compression site. After the recording, the cervical cord was studied histologically. There was demyelination and gliosis in the ventral funiculus and in part of the ventrolateral funiculus at or near the injured site. Electrophysiological and histological findings were in good agreement with the behavioral ones. Behavioral studies seem useful for evaluating the function of the spinal cord, especially for assessing the injured system in the spinal cord.

Animals↗
PubMed2004

Monitoring individual erector spinae fatigue responses using electromyography and near infrared spectroscopy.

This study examined the utility of electromyography and near-infrared spectroscopy (NIRS) in assessing m. erector spinae activity during the Biering-Sorensen Back Muscle Endurance (BSME) test. Six men and four women (27.0 +/- 7.1 years of age) performed the BSME test (time = 131.5 +/- 43.5 s). EMG was used to quantify neuromuscular activity of the right and left side at the L3 level, and root mean square was scaled for maximum value at the start of the exercise. NIRS was used to evaluate blood volume (BV) and oxygenation (OX) simultaneous with EMG bilaterally at the L3 level. There was a decrease to 49+/- 8% of initial median frequency (mean= 83 Hz) on both right and left sides when the exercise was 90% complete, and the slope of the median frequency/time relationship was significantly related to BSME time (r = 0.82). Group means for BV increased during back exercise while OX decreased and was significantly different between right and left sides of the lower back. However, large OX response differences among individuals and between right and left sides were noted. OX and median frequency were moderately related (r = 0.27-0.38). It appears that NIRS combined with EMG is a promising tool for assessing localized metabolic and neuromuscular activity during static contractions of the lower back.

Adult↗
PubMed2003

Synaptic inputs from low threshold afferents of trunk muscles to motoneurons innervating the longissimus lumborum muscle in the spinal cat.

(1) We studied the reflex actions of group I and II afferents to longissimus lumborum (Long) motoneurons in the L1-L5 spinal segments from the epaxial muscle, m. Long, and the hypaxial muscle, m. obliquus externus abdominus (OEA). (2) Postsynaptic potentials (PSPs) recorded from 140 Long motoneurons in 30 spinal cats were analyzed. Under the present experimental conditions, the stimulation of Long and OEA nerves at an intensity below 1.5 times threshold (T) activated only group I muscle afferents, while stimulations at 2-5T activated group II muscle afferents as well. (3) The incidence of PSPs was related to the proximity of the spinal segments of the nerves stimulated to the spinal segment of the motoneurons; the shorter the distance the larger the PSPs and higher incidence of PSPs. The Long motoneurons received group I afferent input mainly from the same and adjacent segments, and received group II afferent inputs from a wider range of segments. (4) A short (i.e., less than 1.0 ms) latency of excitatory PSPs (EPSPs) evoked by ipsilateral group I afferents of Long at the same or adjacent segment indicated a monosynaptic connection. In general, the central latencies became longer as the distance between spinal segments of stimulated nerves and motoneurons increased. Major PSP components were produced by polysynaptic neuronal pathways. The spatial facilitation between PSPs evoked by afferents of different nerves (i.e., ipsilateral Long (iLong) and contralateral Long (cLong) of the same segment; iLongs of different segments; and iLong and iOEA of the same segment) indicated that they shared common interneurons. (5) Although iLong and iOEA muscle afferents produced predominantly EPSPs, and contralateral muscle afferents elicited predominantly IPSPs in Long motoneurons at each spinal segment, the patterns of convergence from Long and OEA muscle afferents of different spinal segments and of different sides differed considerably among motoneurons. (6) These findings demonstrated various input patterns of individual motoneurons within the same motoneuron pool, which might reflect the complexity of neuronal control of the back muscles for various trunk movements, including lateral and dorsal bending, rotating, and fixation of the trunk.

Action Potentials↗
PubMed2005

Effect of whole-body vibration exercise on lumbar bone mineral density, bone turnover, and chronic back pain in post-menopausal osteoporotic women treated with alendronate.

BACKGROUND AND AIMS: Exercise may enhance the effect of alendronate on bone mineral density (BMD) and reduce chronic back pain in elderly women with osteoporosis. The aim of this study was to determine whether whole-body vibration exercise would enhance the effect of alendronate on lumbar BMD and bone turnover, and reduce chronic back pain in postmenopausal women with osteoporosis. METHODS: Fifty post-menopausal women with osteoporosis, 55-88 years of age, were randomly divided into two groups of 25 patients each: one taking alendronate (5 mg daily, ALN) and one taking alendronate plus exercise (ALN+EX). Exercise consisted of whole-body vibration using a Galileo machine (Novotec, Pforzheim, Germany), at an intensity of 20 Hz, frequency once a week, and duration of exercise 4 minutes. The study lasted 12 months. Lumbar BMD was measured by dual energy X-ray absorptiometry (Hologic QDR 1500W). Urinary cross-linked N-terminal telopeptides of type I collagen (NTX) and serum alkaline phosphatase (ALP) levels were measured by enzyme-linked immunosorbent assay and standard laboratory techniques, respectively. Chronic back pain was evaluated by face scale score at baseline and every 6 months. RESULTS: There were no significant differences in baseline characteristics, including age, body mass index, years since menopause, lumbar BMD, urinary NTX and serum ALP levels, or face scale score between the two groups. The increase in lumbar BMD and the reduction in urinary NTX and serum ALP levels were similar in the ALN and ALN+EX groups. However, the reduction in chronic back pain was greater in the ALN+EX group than in the ALN group. CONCLUSIONS: The results of this study suggest that whole-body vibration exercise using a Galileo machine appears to be useful in reducing chronic back pain, probably by relaxing the back muscles in post-menopausal osteoporotic women treated with alendronate.

Accidental Falls↗
PubMed1998

Muscular strain and fatigue among urologists during transurethral resections using direct and monitor endoscopy.

OBJECTIVES: The aims of the study were to analyze muscular strain and fatigue of urologists during the performance of transurethral resections using direct and video endoscopy and to reduce the muscular effort by an ergonomic arrangement of the operation equipment. METHODS: The study was performed before, during and after the introduction of a video-guided resection method. Muscular strain and fatigue were studied by means of surface electromyograms derived from various shoulder and back muscles of surgeons. RESULTS: During direct endoscopy, muscular strain was found to be significantly higher for the shoulder muscles than during monitor endoscopy. The occurrence of muscular fatigue was established for at least one of the muscles under test in all operations during the application of direct endoscopy. A routine use of the video method was facilitated by arranging the operation equipment according to ergonomic principles. This results in a reduction in muscular fatigue, in particular for the trapezius muscle. For this muscle the number of operations accompanied with fatigue was lowered from about 80% before redesign to about 42% after redesign. CONCLUSION: Muscular strain and fatigue of urologists occurring during transurethral resections is reduced by applying video endoscopy instead of using direct endoscopy. The routine use of the video method requires an ergonomic arrangement of the operation equipment.

Adult↗
PubMed1983

Mechanical effectiveness studies of lumbar spine orthoses.

Intradiscal pressures, intra-gastric pressures and myoelectric trunk muscle activities were measured in four volunteers wearing five different orthoses of three principle types, and performing six tasks. A biomechanical model was used to estimate the load on the spine in the different tasks so as to compare those tasks reliably when done with and without the orthoses. The results indicate that wearing a brace can significantly unload the trunk in some situations, but has no effect in others. Lumbar spine compression was reduced by about one-third in the task involving trunk flexion. The disc pressure values with an orthosis were lower in about two-thirds of the exercises and higher in the remaining one-third. The back muscle activity was in some experiments reduced by one-third by the use of the brace, in others it increased by the same amount. None of the orthoses raised the intra-gastric pressure significantly. No one orthosis was found to be clearly superior in mechanical effectiveness in the tasks studied.

Adult↗
PubMed2004

[Hemi-hangback recession (retroposition) of extraocular muscles].

In a small clinical study the author evaluates the efficiency of the hemi-hangback recession (retroposition) procedure. This surgical procedure, which weakens extraocular muscles, proceeds from the hangback recession (retroposition) technique (hanging the muscle on a resorbable suture), which combines with the traditional recession. Hemi-hangback recession procedure is suitable in cases when a recession of more than 7 mm is needed. It is experimentally and clinically as well demonstrated in extra large recessions, that a shift towards the original insertion of the muscle occurs. The combination of the classical and hangback recession has its advantages in specific indications. More convenient surgical access and a reduction of the objectionable shift of the muscle backwards are main advantages of this procedure. The surgical procedure is described in this article and results in the group of patients from the Children's and Adult's Department of Ophthalmology at the Faculty Hospital in Motol, Prague, Czech republic. The hemi-hang-back muscles recession is indicated in third and sixth nerve palsies, restrictive forms of strabismus and complicated or successive forms of strabismus.

Adult↗
PubMed2001

Role of cartilage-derived anti-angiogenic factor, chondromodulin-I, during endochondral bone formation.

OBJECTIVE: Cartilage is a typical avasclar tissue that exhibits powerful resistance to angiogenesis or vascular invasion. We previously identified a cartilage-specific 25 kDa glycosylated protein, chondromodulin-I (ChM-I), as anti-angiogenic factor. Taking advantage of ectopic bone formation and xenograft tumour model by human chondrosarcoma cell line OUMS-27, we examined how ChM-I is involved in switching of angiogenesis in cartilage. DESIGN: Gene expression pattern of ChM-I was examined in 4-week-old mice and mouse embryos by northern blot analysis and in situ hybridization. To evaluate the effect of ChM-I on ectopic bone formation, guanidine extracts of demineralized bone matrix were mixed with the ChM-I-bound heparin-Sepharose beads and were implanted onto the fasciae of back muscle of 6-week old nude mice. To analyse the effect of ChM-I on tumour angiogenesis, the level of ChM-I mRNA in cartilaginous tumours was assessed by competitive PCR, and compared with that of articular cartilage. Then, human chondrosarcoma OUMS-27 cells were inoculated into the back of nude mice to form a tumour about 45 mm3 in size. Recombinant ChM-I protein was administrated into OUMS-27 xenograft tumours for the initial 5 days to study its effect against tumour-angiogenesis. RESULTS: ChM-I gene was specifically expressed in cartilage of 4-week-old mice. Eye and thymus were also identified as minor expression sites. However, during endochondral bone development, cartilage changes its character from anti-angiogenic into angiogenic prior to the replacement of calcified cartilage by bone. In embryos, ChM-I mRNA was expressed in proliferative and upper hypertrophic cartilage zones in the developing cartilaginous bone rudiments, but completely abolished in lower hypertrophic and calcified cartilage zones. Purified ChM-I protein apparently inhibited vascular invasion into cartilage induced by the implantation of demineralized bone matrix in nude mice, leading to the inhibition of replacement of cartilage. The level of ChM-I transcripts in the lower-grade chondrosarcomas was substantially reduced to several hundreds or less in the lower-grade chondrosarcomas, compared with that of articular cartilage or other benign cartilage tumours. The local administration of recombinant human ChM-I almost completely blocked tumour angiogenesis and growth in the human chondrosarcoma xenografts in mice. CONCLUSIONS: ChM-I is involved in the anti-angiogenic property of cartilage and its absence creates a permissive microenvironment for vascular invasion into cartilage under physiological and pathological conditions.

Animals↗
PubMed2003

Muscle synergies during shifts of the center of pressure by standing persons: identification of muscle modes.

When a standing person performs a movement such that the center of gravity shifts, the activity of postural muscles adjusts to keep the balance. We assume that such adjustments are controlled using a small set of central variables, while each variable induces changes in the activity of a subgroup of postural muscles. The purpose of this study has been to identify such muscle groups (muscle modes or M-modes) and compare them across tasks and subjects. Four tasks required the subjects to release a load from extended arms leading to a center of pressure (COP) shift prior to the load release. The fifth task required an explicit COP shift by voluntary sway. Electromyographic activity of 11 postural muscles on one side of the body was integrated over a 100-ms interval corresponding to the early stage of the COP shift, and this integrated EMG activity was subjected to a principal component (PC) analysis across multiple repetitions of each task. Three PCs were identified and associated with a "push-back M-mode," a "push-forward M-mode," and a "mixed M-mode." Cluster analysis of the PC vectors across tasks and across subjects confirmed the existence of distinctive push-forward and push-back muscle groups. PC vectors were also compared across tasks and across subjects using cosines as a measure of colinearity between pairs of vectors. In general, M-modes were similar across both tasks and subjects. We conclude that shifts of the COP, whether implicit or explicit, are controlled using a small set of central variables associated with changes in the activity of robust subsets of postural muscles. These results can be used for future analysis of muscle synergies associated with postural tasks.

Adult↗
PubMed1994

Instrumental straight-leg raising: results in patients.

Straight-leg raising is used as a diagnostic test for both elastogenic (passive muscle stretch test) and nonelastogenic (Lasègue's test) pathology in patients unable to bend forward from the standing position while holding the knees in extension. The test assessment is based on the range of the leg excursion and the type of pain that is provoked. An instrumental version of Lasègue's test (instrumental straight-leg raising) provides information about the extensibility, elasticity and electrical activity of the hamstrings and back muscles and about pelvic rotation. To investigate the diagnostical value of the additional information, both clinical and instrumental straight-leg raising was done by 30 patients who were unable to touch the ground while bending forward from the standing position with the knees extended. In one group of patients, the electrical activity of the muscles was comparable to that observed in the muscles of a control group of healthy volunteers; in a second group, however, the electrical muscle activity was aberrant. Muscle extensibility and passive muscle elasticity was comparable in patients in the first group and the healthy controls. In the patients with aberrant muscle activity, the elasticity of the passive muscles was not different from the control group, but both leg excursion and muscle extensibility were much smaller. Comparison of the clinically and experimentally diagnosed cause (elastogenic or non-elastogenic) of the movement restriction showed a remarkable discrepancy. We conclude that instrumental straight-leg raising provides valuable additional diagnostical information.

Adolescent↗
PubMed2005

Vitamin D deficiency and reduced bone mineral density in multiple sclerosis: effect of ambulatory status and functional capacity.

Multiple sclerosis (MS) is a chronic disease and a major cause of disability in young adults. The aims of this study were to assess bone mass in patients with MS in comparison to healthy age- and sex-matched controls, and to evaluate factors influencing bone mineral density (BMD), and the relationship of the pain threshold at peripheral and axial sites with BMD in MS. Thirty-one patients with MS and 30 matched healthy controls participated in the study. The Kurtzke expanded disability status scale (EDSS) and the functional independence measure (FIM) were used to scale disability, mobility, and functional status. Serum 25(OH) vitamin D levels were measured. BMD was measured using dual X-ray absorptiometry (DXA). MS patients had significantly lower BMD at the lumbar spine (L2-L4) and femur trochanter compared to the matched controls. BMD of the lumbar spine was nearly 1 SD lower in MS patients compared with the healthy reference population (Z scores). MS patients had significantly lower vitamin D levels (17.3 ng/ml vs 43.1 ng/ml; P < 0.001) compared to controls, and 19 patients (61%) had a serum level of vitamin D that was less than 20 ng/ml. EDSS scores in the patients were inversely correlated with proximal femur BMD but not with spinal BMD. There was a negative correlation with the cumulative steroid dose and BMD only for femur trochanter BMD. Total myalgia scores for paravertebral muscles correlated significantly with spinal BMD. In conclusion, BMD is significantly lower in MS patients than in healthy controls, vitamin D deficiency is prevalent in MS, and ambulatory status is a determinative factor for osteoporosis in MS. Patients should be encouraged to have adequate sunlight exposure and to increase their mobility. Specific strengthening exercises for hip and back muscles in MS patients would have a substantial impact on bone density, osteoporosis, fracture risk, and mobility.

Adult↗