Browsing by Author "Gabel, Leigh"

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    Bone health and physical activity in adolescents with juvenile idiopathic arthritis: a cross-sectional case-control study
    (2024-04-19) Vasil, Egi; M. Nesbitt, Colleen; Toomey, Clodagh; Kuntze, Gregor; Esau, Shane; A. Emery, Carolyn; Gabel, Leigh
    Abstract Background Adolescents with juvenile idiopathic arthritis (JIA) tend to engage in less physical activity than their typically developing peers. Physical activity is essential for bone development and reduced physical activity may detrimentally effect bone health. Thus, we examined differences in total body bone mineral content (BMC) and areal bone mineral density (aBMD) between adolescents with JIA and adolescent controls without JIA. We also examined associations between moderate-to-vigorous physical activity (MVPA), lean mass, and bone outcomes. Methods Participants included 21 adolescents with JIA (14 females, 7 males) and 21 sex- and age-matched controls aged 10–20 years. Assessments included: height; weight; triple-single-leg-hop distance (TSLH); MVPA by accelerometry; and total body BMC, aBMD, and lean mass measured using dual X-ray absorptiometry. Height-adjusted z-scores were calculated for BMC and aBMD and used for all analyses. Multiple linear mixed effects models examined group differences in BMC and aBMD, adjusting for sex, maturity, MVPA, TSLH, and lean mass. Participants clusters, based on sex and age (within 18 months), were considered random effects. Results Adolescents with JIA had lower total body aBMD z-scores [β (95% CI); -0.58 (-1.10 to -0.07), p = 0.03] and BMC z-scores [-0.47 (-0.91 to -0.03), p = 0.04] compared with controls. Mean daily MVPA was 22.0 min/day lower in adolescents with JIA than controls; however, MVPA was not associated with aBMD [-0.01 (-0.01 to 0.01), p = 0.32] or BMC [0.00 (-0.01 to 0.00), p = 0.39]. Lean mass was positively associated with aBMD [0.05 (0.01 to 0.09) g/cm2, p = 0.03] and BMC [0.06 (0.03 to 0.10) g, p < 0.001]. Conclusion Adolescents with JIA had lower total body aBMD and BMC compared with sex- and age-matched controls without JIA. Group differences in bone outcomes were not associated with the lower MVPA participation of adolescents with JIA. Despite this, physical activity should still be encouraged as it promotes physical well-being.
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    Bone Loss and Fracture Risk Following Spinal Cord Injury: Patient Priorities and Treatment Options
    (2024-04-22) Crack, Laura Elizabeth; Edwards, W. Brent; Gabel, Leigh; Kline, Greg
    Rapid and profound bone loss is a well-known secondary complication following spinal cord injury (SCI), occurring primarily below the level of neurological lesion due to mechanical disuse. The greatest loss of bone is experienced during the acute phase of injury, and established osteoporosis often persists into the chronic phase, with no current standard care plan for patients. The main goals of this thesis were to: (1) explore patient knowledge and awareness regarding bone loss, fracture risk and treatment options following SCI, and (2) to investigate pharmaceutical treatment options to prevent bone loss in acute SCI, as well as treat established osteoporosis in chronic SCI. Three independent studies were carried out and are presented in Chapters 3-5, respectively. Survey results demonstrated that while more than half of participants with SCI were able to correctly answer knowledge-based questions regarding bone health, less than one-fifth had received education on the topic, and approximately three-quarters were interested in learning more about treatment options. Our clinical trials demonstrated the efficacy of zoledronic acid (antiresorptive therapy) to mitigate loss of bone mineral and strength at the hip in acute SCI, regardless of one’s ability to regain ambulation following injury, and the efficacy of romosozumab (anabolic and antiresorptive monoclonal antibody therapy) to increase bone mineral and strength at the hip, but not the knee, in women with chronic SCI. These findings add to the existing body of literature suggesting zoledronic acid is a strong candidate for standard of care to mitigate bone loss during acute SCI, and indicating that further investigation is required to find a treatment that can increase bone mineral, and reduce fracture risk, at both the hip and knee during chronic SCI for those with established osteoporosis.
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    The influence of two physical activity programs on bone and muscle health in youth with cerebral palsy and other neuromotor impairments.
    (2025-01-06) Hodgson, Erin; Condliffe, Elizabeth G.; Gabel, Leigh; Manske, Sarah; Kirton, Adam
    Weight-bearing physical activity is crucial for building strong bones, especially during childhood and adolescence when bones grow rapidly. During this time, physical activity, muscle-bone interactions, and gravity help stimulate bone development. However, in conditions that limit mobility, such as cerebral palsy (CP) and other non-progressive neuromotor impairments (CP-like), physical activity is reduced, which can lead to poor bone health. This increases the risk of fractures and may lead to osteoporosis in adults with CP. This thesis examines bone health in children and youth with CP and CP-like conditions using peripheral quantitative computed tomography (pQCT) scans of the tibiae. Bone and muscle parameters, including bone mineral content (BMC), bone mineral density (both trabecular and cortical; BMD), bone size, and muscle size, were compared to age-, sex-, and ethnicity-matched peers from a typically developing population. A total of 22 participants from all Gross Motor Function Classification System (GMFCS) levels (I-V) were included. This study found smaller, thinner and weaker bones and lower muscle strength in children and adolescents with CP and CP-like conditions across all GMFCS levels, with deficits relating to functional ability. As weaker bones increase the incidence of fragility fractures, causing pain and predisposing future comorbidities, this thesis further evaluated the effects of two physical activity programs on bone and muscle strength. Robot-assisted walking in three participants with the greatest functional limitations found upright mobility may improve bone strength. In contrast, power training in eight participants with the greatest functional abilities found no adaptations in bone or muscle. These findings suggest that while bone health is a concern across all functional abilities, adaptations appear to correlate to the loading one previously experienced, having the greatest impacts in those who do not regularly ambulate. This highlights the importance of tailored physical activity programs based on functional ability during growth and could inform strategies for improving musculoskeletal health in children and youth with CP and CP-like conditions.
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    Using High Resolution Peripheral Quantitative Computed Tomography to Evaluate Bone Health and Relative Energy Deficiency in Sport Risk in Elite Winter Sport Athletes
    (2024-08-27) Smith, Emily Marie; Boyd, Steven; Burt, Lauren; Roach, Koren; Gabel, Leigh; Kenny, Sarah
    Relative Energy Deficiency in Sport (REDs) is a syndrome resulting from problematic low energy availability (LEA). Low areal bone mineral density (aBMD) is a primary indicator of LEA and is measured at the hip or spine by dual X-ray absorptiometry (DXA). High-resolution peripheral quantitative computed tomography (HR-pQCT) measures volumetric BMD (vBMD), microarchitecture, geometry, and estimated strength reported as failure load. The objective of this study was to assess the differences in bone parameters using HR-pQCT in elite winter sport athletes identified as at-risk or not at-risk of REDs using the Clinical Assessment Tool (CAT2). Participants included 101 athletes (24.14.4 SD years; 53% female). HR-pQCT scans of the non-dominant radius and left tibia were analyzed and compared to DXA results. Seventeen athletes (17%; 71% female) were at-risk of REDs based on the CAT2. Bland-Altman plots suggested that compared to aBMD, Z-scores were more like failure load (ICC=0.420.10) than vBMD (ICC=0.250.07). After covarying for lean mass, odds ratios (OR) suggested increased likelihood of REDs risk classification for those with low cortical thickness (radius: OR=2.14, p=0.021; tibia: OR=1.89, p=0.037), and area (radius: OR=3.04, p=0.007; tibia: OR=2.74, p=0.006), total vBMD (tibia: OR=2.06, p=0.030), and failure load (tibia: OR=2.17, p=0.033). ROC-AUC analysis showed very poor to poor (0.50