Disruption of bone and skeletal muscle in severe burns

Abstract

Severe burn injury triggers the body's nonspecific adaptive responses to acute insult, including the systemic inflammatory and stress responses, as well as the sympathetic response to immobilization. These responses trigger inflammatory bone resorption followed by glucocorticoid-induced apoptosis of osteoblasts and probably osteocytes. Because these patients are catabolic, they suffer concomitant muscle wasting and negative nitrogen balance. The use of anabolic agents such as recombinant human growth hormone and oxandrolone results in improved bone mineral content and muscle strength after approximately 1 year. Use of bisphosphonates within the first 10 days of a severe burn completely blocks the resorptive bone loss and has the added advantage of appearing to preserve muscle protein from excessive breakdown. The mechanism for the protective effect on muscle is not currently known. However, if the effect of bisphosphonates on muscle can be confirmed, it raises the possibility that bone communicates with muscle.

Osteoporosis: Bone may communicate with muscle

Bisphosphonates, drugs commonly used to treat bone loss, may also protect muscle which would be good news for osteoporosis patients. In a review article, Gordon Klein from the University of Texas Medical Branch looked at bone loss and muscle breakdown following severe burns. Studies in children showed that the use of growth hormone or oxandrolone, an anabolic steroid, after severe burns can improve bone mineral content and muscle strength after one year. However, administering bisphosphonates within the first ten days after a severe burn stopped bone loss and appeared to preserve muscle protein from excessive breakdown. If the effects of these drugs on muscle are confirmed it raises the possibillity that bone communicates with muscle. Patients with osteoporosis and muscle loss would benefit if treatment for bone loss also resulted in preservation of muscle mass.

References

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