Bone disease in burn patients

Gordon L. Klein, David Herndon, Thomas C. Rutan, Donald J. Sherrard, Jack W. Coburn, Craig B. Langman, Mary L. Thomas, John G. Haddad, Cary W. Cooper, Nancy L. Miller, Allen C. Alfrey

Research output: Contribution to journalArticle

88 Citations (Scopus)

Abstract

Burn patients are at risk for bone disease due to aluminum (Al) exposure from use of antacids and albumin, partial immobilization, and increased production of endogenous glucocorticoids. Moreover, severely burned children are growth impaired up to 3 years after the burn. To determine the extent of bone disease, we studied nine men and three women, ages 18-41 years, with greater than 50% body surface area burn. Seven patients underwent iliac crest bone biopsy following double tetracycline labeling, one additional patient expired after a single label, and three others had postmortem specimens obtained for quantitative Al only. Serial serum and urine samples were obtained weekly until biopsy or death. All biopsied patients had reduced bone formation and osteoid area, surface, and width, with mineral apposition rate, osteoblast surface, and osteoclast number with normal eroded surfaces compared to age- and sex-matched normal ambulatory volunteers. Burn patients also had reduced bone formation, mineral apposition rate, osteoid area, and surface compared to age-matched volunteers at short-term bed rest. Serum levels of osteocalcin were low. Most patients had mild hypercalcemia but only a third had hypercalciuria. All patients had elevated Al in blood or urine; urine Al correlated inversely with serum osteocalcin. In 60% significant bone Al was detectable by stain or quantitation. Our data are compatible with burn patients having markedly reduced bone turnover. Al loading, partial immobilization, endogenous corticosteroids, and cytokine production may be among the etiologic factors.

Original languageEnglish (US)
Pages (from-to)337-345
Number of pages9
JournalJournal of Bone and Mineral Research
Volume8
Issue number3
StatePublished - Mar 1993

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Bone Diseases
Aluminum
Osteocalcin
Urine
Osteogenesis
Immobilization
Minerals
Serum
Biopsy
Hypercalciuria
Bone and Bones
Antacids
Bed Rest
Bone Remodeling
Body Surface Area
Hypercalcemia
Osteoclasts
Tetracycline
Osteoblasts
Glucocorticoids

ASJC Scopus subject areas

  • Surgery

Cite this

Klein, G. L., Herndon, D., Rutan, T. C., Sherrard, D. J., Coburn, J. W., Langman, C. B., ... Alfrey, A. C. (1993). Bone disease in burn patients. Journal of Bone and Mineral Research, 8(3), 337-345.

Bone disease in burn patients. / Klein, Gordon L.; Herndon, David; Rutan, Thomas C.; Sherrard, Donald J.; Coburn, Jack W.; Langman, Craig B.; Thomas, Mary L.; Haddad, John G.; Cooper, Cary W.; Miller, Nancy L.; Alfrey, Allen C.

In: Journal of Bone and Mineral Research, Vol. 8, No. 3, 03.1993, p. 337-345.

Research output: Contribution to journalArticle

Klein, GL, Herndon, D, Rutan, TC, Sherrard, DJ, Coburn, JW, Langman, CB, Thomas, ML, Haddad, JG, Cooper, CW, Miller, NL & Alfrey, AC 1993, 'Bone disease in burn patients', Journal of Bone and Mineral Research, vol. 8, no. 3, pp. 337-345.
Klein GL, Herndon D, Rutan TC, Sherrard DJ, Coburn JW, Langman CB et al. Bone disease in burn patients. Journal of Bone and Mineral Research. 1993 Mar;8(3):337-345.
Klein, Gordon L. ; Herndon, David ; Rutan, Thomas C. ; Sherrard, Donald J. ; Coburn, Jack W. ; Langman, Craig B. ; Thomas, Mary L. ; Haddad, John G. ; Cooper, Cary W. ; Miller, Nancy L. ; Alfrey, Allen C. / Bone disease in burn patients. In: Journal of Bone and Mineral Research. 1993 ; Vol. 8, No. 3. pp. 337-345.
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