RESUMO
Immobilization secondary to spinal cord injury is associated with a marked and rapid atrophy of trabecular bone (disuse osteoporosis). This is due to an early increase of osteoclastic bone resorption associated with a pronounced decreased osteoblastic bone formation. Bisphosphonates are antiosteoclastic compounds and they have been effective in preventing disuse osteoporosis. However, some of them also depress osteoblastic activity and may impair the mineralization process. Tiludronate was shown effective in reducing bone resorption in several metabolic bone diseases without inducing mineralization defects. Twenty paraplegic patients (6 females and 14 males) were randomly assigned to three groups: 6 patients entered the placebo group; 7 patients received tiludronate 200 mg/day; and 7 received 400 mg/day. Histomorphometric analysis was performed on transiliac bone biopsies before and after 3 months treatment. An insignificant decrease of bone volume was observed in the placebo group and the 200 mg group. In patients receiving 400 mg/day, a slight increase was noted. Osteoid parameters changed nonsignificantly in three groups although the 400 mg group exhibited a slight tendency to decrease osteoid volume and thickness. Eroded surfaces increased in all groups. The number of osteoclasts (identified histochemically by TRAP staining) increased in the placebo group but decreased in groups receiving tiludronate. Tiludronate appears effective in reducing bone resorption without impairing bone formation in a manner that preserved bone mass and bone cell coupling.
Assuntos
Densidade Óssea/efeitos dos fármacos , Difosfonatos/uso terapêutico , Osteoporose/prevenção & controle , Paraplegia/patologia , Traumatismos da Medula Espinal/patologia , Adolescente , Adulto , Análise de Variância , Biópsia , Reabsorção Óssea/prevenção & controle , Difosfonatos/administração & dosagem , Difosfonatos/farmacologia , Método Duplo-Cego , Feminino , Humanos , Ílio/efeitos dos fármacos , Ílio/fisiologia , Imobilização/efeitos adversos , Masculino , Pessoa de Meia-Idade , Osteoclastos/efeitos dos fármacos , Osteoporose/tratamento farmacológico , Osteoporose/etiologia , Paraplegia/complicações , Traumatismos da Medula Espinal/complicaçõesRESUMO
The Medical Social Service in the 'Centro Nacional de Rehabilitación de Parapléjicos' of Toledo is briefly explained. Until 30 April 1975, 141 patients were treated in this hospital and the pertinent statistics are shown. The main social problems were housing, pension and job. The Medical Social Service makes use of all its resources to solve these problems.
