The Natural History of Injury-Related Disuse Osteopenia

It is well documented that restricted weight bearing even for relatively short periods (12 weeks) associated with the surgical treatment of peri-articular injuries of the lower extremity (ie acetabulum, distal femur, tibial plateau, pilon, talus, calcaneus) can lead to a measurable decrease in bone density in the injured limb. Furthermore, this osteopenia can persist for extended periods of time - much longer than the original period of restricted weight bearing. This relative osteopenia can delay recovery from injury, lower fracture threshold for subsequent injury and potentially delay return to active duty in the case of a wounded warrior. There exists a significant body of research in the modulation of the osteopenia associated with restricted weight bearing as it pertains to long term space flight (microgravity).

Inclusion criteria

• Age 18-70 at time of injury
• Previously normal community ambulator (without ambulatory aid) prior to injury

Exclusion criteria

• Presence of a total or hemi hip prosthesis in the injured extremity
• Presence of lumbar fusion L1-L4
• Previous ipsilateral lower extremity trauma
• History of medical treatment for known osteoporosis (Calcium and Vitamin D supplementation alone is NOT an exclusion criteria)
• Ambulatory dysfunction prior to injury
• Inability to cooperate with DXA scanning
• Head injury on admission requiring invasive monitoring or treatment
• Inability to adhere to weight bearing restrictions
• Inability to provide consent
• Non English speaking
• Pregnancy