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Discussion

Vibration training is a relatively new treatment option used for potential benefits to muscle and/or bone health. However, none of the current evidence supports its efficacy in improving bone health.

Conclusion

There is level 4 evidence (from 2 pre-post studies) (Wuermser et al. 2015; Dudley-Javoroski et al. 2016) that standing on a low-magnitude vibration plate did not improve BMD or microstructure at the proximal femur or distal tibia and did not significantly change bone turnover biomarkers.

There is level 4 evidence (from 1 pre-post study) (Melchiorri et al. 2007) that vibration training did not improve or maintain BMC in the arms.

Table 14. Vibration Treatment for Bone Loss in Chronic SCI

Author Year; Country
Score
Research Design
Total Sample Size
MethodsOutcome
Dudley-Javoroski et al. 2016

Pre-post

2016

USA

N=7

Population: 7 participants (5 men, 2 women); age: 38.1 ± 19.6 years; TPI: 5.9 (range: 0.1-29.2); 6 thoracic, 1 cervical; AIS-A/B: 5/2; TPI at first pQCT: 5.6 ± 6.5 years; TPI at first CT: 7.4 ± 4.9 years.

 

Treatment:

n=6; 12 months of vibration; mean of > 2.14 sessions/week, for 112-152 sessions

One leg of each participant underwent vibration (+ cycles of 10-35% body weight), the other acted as control

 

n=1 did not participate in vibration (participant 1); followed-up at 2.7 years post-SCI (first pQCT & CT @ 0.14 & 0.36 years post-SCI)

 

Outcome Measures:

BMD and bone micro-architecture variables including network length, plate volume fraction, and others.

Variables measured via peripheral quantitative CT (pQCT) and high-resolution CT (CT).

CT analyzed at multiple regions and peel* modes

 

*Removal of voxels corresponding to 30, 45, and 60 % from the trabecular envelope; peripheral peel = removal of 60% peel from 30% peel.

1.        pQCT found no significant training (yes/no) x time (pre/post) interaction for BMD of either tibia or femur

2.      CT found significant training x time and training x region interactions only for certain variables at certain peels and regions of tibia and femur

3.      pQCT found a significant decline in distal femur & tibia BMD post-training but found no overall decline femur or tibia BMD

4.     CT found significant post-training decreases in BMD and network length with 30% peel at distal tibia & femur

5.      CT found a mean post-training decrease of 24.3% in BMD and 14.4% in NL across all regions of tibia, and 29.5% and 35.5% for femur.

6.      pQCT found a mean follow-up** BMD decrease of 55.9% for distal tibia, and 73.4% for distal femur.

7.      CT found a mean follow-up** decrease of 48.1% in BMD, and 41.9% in NL distal tibia, and 53.6% in BMD, 38.1% in NL & 2,9% in PVF for distal femur.

8.     Loss** of BMD and architecture greatest at ultra-distal tibia and central epiphysis of femur

**Follow-up of participant 1 at 2.7 years post-SCI

Wuermser et al. 2015

USA

2015

Pre-post N=9

 

 

Population: 9 participants (5 men, 4 women) with chronic traumatic motor complete paraplegia; age: 42 ± 8 years; TPI: 2-27 years; AIS- A or B; BMI: 22.3 ± 4.1 kg/m2.

 

Treatment: Whole-body low-magnitude vibration (Juvent Medical, Somerset, NJ,

USA; model Juvent 1000) using a standing frame for 20 minutes per day, 5 days a week, and for 6 months. The vibrating plate provides a 0.3 g, 34 Hz vertical sinusoidal movement of ~50 μm.

 

Outcome measure: Areal bone mineral density (aBMD; DXA, Lunar Prodigy system, GE Healthcare, Madison, WI, USA) at the proximal femur; distal tibia total trabecular and cortical volumetric BMD (vBMD; HRpQCT (XtremeCT, Scanco Medical AG Brüttisellen, Switzerland), and bone microstructure; bone turnover biomarkers: C-terminal telopeptide of type I collagen (CTX; Roche Cobas e411 (Roche Diagnostics, Indianapolis, IN, USA), amino-terminal pro-peptide of type I collagen (, P1NP; double-antibody radioimmunoassay, Orion Diagnostica, Espoo, Finland) and serum, sclerostin (enzyme-linked immunosorbent assay, Biomedica, Wien, Germany; distributed in USA by ALPCO, Salem, NH, USA);) and body composition measurements: total body lean mass (kg) and total body fat mass (kg) and BMI (kg/m2). Assessed at baseline, 3 and 6 months during the intervention and 6 months after the intervention.

1.        Average use of the whole-body vibration platform: 20-60 min per day, 5x per week.

2.      aBMD: no significant change at the proximal femur sites (baseline: 0.75 ± 0.20 g/cm2; post-intervention: 0.74± 0.18 g/cm2). However, three subjects had an increase in total hip aBMD that was greater than the minimal detectable difference.

3.      vBMD and microstructure: no significant differences in either the trabecular (Tibia: trabecular thickness baseline: 0.04 ± 0.03 mm; post-intervention: 0.04 ± 0.03 mm) or cortical compartments (Tibia cortical thickness pre: 0.80 ± 0.28 mm; post-intervention: 0.78 ± 0.31 mm). No change greater than the minimal detectable difference was identified.

4.     No significant improvement in aBMD at the proximal femur or vBMD after 6 months of intervention, or any relevant changes 6 months following the discontinuation of the low-magnitude vibration.

5.      No significant change or relevant trend in bone turnover biomarkers or total or lower extremity, lean mass or fat mass over follow-up.

Melchiorri et al. 2007

Italy

Pre-Post

N=10

Population: 10 men; age: 34 ± 4 years; traumatic SCI; Level of injury: between 8th and 10th dorsal vertebra; TPI: 8 ± 3 years.

Treatment: Vibration using handlebars and four series of maximal speed arm curls with the load being increased with each series to 5,8,10, and 15% of individual’s body weight (handlebar and extra load together) at frequency of 30 Hz. Subjects exposed to vibrations for 12 weeks, 5x/week, 5min/session.

Outcome measures: BMC and BMD by DXA (total body)

1.     Total DXA measurements corresponding to BMC and BMD showed no statistically significant differences between three-time points. Segmental analysis showed a non-significant increase in BMD for both arms.

* All data expressed as mean±SD, unless expressed otherwise.