Prevalence and severity of bone loss in burned patients

- Bone loss in burn victims is frequently observed by clinicians.
- The average T-score, Z-score and BMD in significantly lower in thermal burn victims.
- Lumbar vertebra shows most changes in BMD in relation to burns.
- The extent of bone loss is related to the surface area of burn.
- There is a higher prevalence of osteoporosis and osteopenia in thermal burn victims.

Often discovered late during the clinical course of burns, bone loss is widely accepted by clinicians as a de facto consequence of burn. Literature on this bone loss is limited and contradictory in details. More insight into the prevalence and magnitude of bone loss may facilitate its prevention. To this end, over a period of two years, we gathered a test group of 34 male patients with at least six-month-old thermal burns and a control group of 50 male members of similar age and geographical background as our test group. All members with any history of metabolic or endocrine disease or ICU admission were excluded from both groups. Using dual energy X-ray absorptiometry (DXA), we measured bone mineral density (BMD), Z-score and T-score in lumbar vertebra, femoral neck, and total femur and compared the results between the two groups. T-test of density scores against total body surface area of burns was performed. We found that the average T-scores, Z-scores and BMDs in the test group were significantly smaller than the averages in the control group (P < 0.001); and in the test and the control group, 25.7% and 0% of subjects respectively, had osteoporotic lumbar T-scores. Total femur and femoral neck T-scores exhibited a significant similar pattern with smaller differences across the two groups. The density scores also showed a significant reverse relationship to the total body surface area (TBSA) of burn (P < 0.003). Our results indicate that thermal burn victims have lower bone density and higher prevalence of osteoporosis than their healthy counterparts and that this difference is significant enough to justify screening in these patients which requires further longitudinal studies to institute.