ltrasound-based investigation of unilateral osteopenia in patients with CRPS of lower extremities compared to peripheral nerve lesions and postoperative or traumatic immobilization.
- Conditions
- Other mononeuropathies of lower limbM89.0G57.9Z76.9G57.8M80M81AlgoneurodystrophyMononeuropathy of lower limb, unspecifiedPerson encountering health services in unspecified circumstances
- Registration Number
- DRKS00013762
- Lead Sponsor
- Abteilung für Endokrinologie und DiabetologieMedizinische Klinik Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil GmbHUK RUB
- Brief Summary
ocal osteopenia and altered bone metabolism are major complications of complex regional pain syndrome (CRPS), but quantitative assessment is difficult unless using X-ray or dual-energy X-ray absorptiometry. Ultrasound-based measurement of bone density (UBD) is a possible alternative but has never been used to detect unilateral disease such as CRPS. Therefore, the main outcome measure of this prospective study was the diagnostic utility of UBD in patients with lower-limb CRPS. Second, we compared the extent of unilateral and contralateral calcaneal bone density to that of other conditions with unilateral pain, general osteoporosis, and healthy subjects. Calcaneal osteodensitometry was bilaterally examined using ultrasound-based methodology. Bone mineral density values were converted to Z-scores based on age- and sex-dependent reference values. All patients completed a functional and an osteoporosis risk questionnaire. In patients with CRPS (n = 18), the bone mineral density values and Z-scores were significantly lower in both the affected (mean ± SD: 0.40 ± 0.08 and -1.1 ± 0.8, respectively) and nonaffected (0.46 ± 0.09 and -0.6 ± 0.9, respectively) limbs than in patients (n = 40) with other unilateral pain syndromes (affected: 0.51 ± 0.1 and -0.2 ± 1.1, respectively; nonaffected: 0.54 ± 0.11 and 0 ± 0.9, respectively) and healthy subjects (right side: 0.6 ± 0.1 and 0.1 ± 0.9, respectively). Conversely, in patients with known systemic osteoporosis, the Z-scores were lower bilaterally with smaller side-to-side differences than in those with CRPS (P < 0.05). Compared with subjects suffering from long-term CRPS (=2.4 years), patients with shorter disease duration exhibited significantly lower Z-scores (P < 0.05). In conclusion, UBD revealed that CRPS is associated with both local and systemic alterations of bone metabolism.
- Detailed Description
Not available
Recruitment & Eligibility
- Status
- Complete
- Sex
- All
- Target Recruitment
- 258
1. Patients suffering from CRPS, which were exposed to prolonged immobilisation or partial weight-bearing due to surgery or due to pain in hip or knee joints or appendicular bones.
2. Control collectives:
a. Healthy individuals
b. Patients suffering from osteopenia or osteoporosis
Missing informed consent – contraindications for SAHARA measurements (including local infection, skin lesions, hyperalgesia due to mechanical contact, metal implants in situ) – fractures with direct calcaneal affection – bilateral disease – insufficient knowledge of the German language or other problems affecting communication – severe cognitive or psychiatric disorders.
Study & Design
- Study Type
- observational
- Study Design
- Not specified
- Primary Outcome Measures
Name Time Method Bone mineral density, as determined by ultrasound-based measurement, is unilaterally significantly reduced both in early-stage CRPS and in extensive nerve injury, resulting in significantly increased lateral difference compared to the non-affected side.
- Secondary Outcome Measures
Name Time Method The lateral difference ob bone mineal densitiy, as determined by ultrasound-based measurement, is larger in CRPS compared to other unilateral diseases. After re-mobilisation an increase in bone mineral density is observed, which is, however, reduced in CRPS compared to other diseases.<br>