Men with chronic traumatic brain injury have lower bone density at cortical sites and altered hip geometric indices as compared to able-bodied peers: A case-control study from India.

BACKGROUND

Patients who have sustained traumatic brain injuries (TBI) exhibit an increased propensity for osteoporosis, characterized by a heightened susceptibility to bone demineralization, and fractures. Despite this recognized risk, the systematic evaluation of bone mineral density (BMD) remains sub-optimal in our current clinical protocols. Therefore, we aimed to compare BMD in male patients with TBI against a cohort of healthy controls.

METHODS

This case-control study was conducted in the Department of Physical Medicine and Rehabilitation at a tertiary care center in South India. BMD, trabecular bone score (TBS), and hip structural analysis (HSA) were assessed using a Dual-Energy X-ray Absorptiometry (DXA) scanner. Males aged 18-45 years with moderate-to-severe TBI within the preceding 6 to 24 months, and age, gender- and body mass index (BMI)-matched able-bodied controls, were recruited from the local community.

RESULTS

A total of 66 individuals who had sustained TBI, with a mean (SD) age of 32.8(5.7) years and 66 age-matched controls with a mean (SD) age of 33.3(5.6) years were included. Hypopituitarism was found in 37 (56.1%) patients. The BMD at the total hip (p = 0.028) was significantly lower among cases as compared to the control group. Among the parameters of HSA, the buckling ratio (BR) was significantly higher at the femoral neck (10.5(2.6) vs 9.6(2.4); p = 0.029), and the inter-trochanteric region (8.6(2.0) vs 7.8(1.9); p = 0.028) among cases as compared to controls, suggesting a high risk of fracture. Although total body fat percentage and visceral adipose tissue levels did not differ significantly between groups, patients with hypopituitarism demonstrated elevated visceral adipose tissue, highlighting the necessity for targeted cardiometabolic risk screening in this population.

CONCLUSION

This study emphasizes the importance of early assessment and treatment of osteoporosis, as TBI can heighten the risk of falls and fractures.