Effects of Lower Limb Amputations on Bone Health of Amputees: Study from A Developing Country

Objective: To measure the BMD in young adults with traumatic or non-traumatic lower limb amputation, using DEXA scan. Study Design: Comparative cross sectional study Place and Duration: Armed Forces Institute of Rehabilitation Medicine from July to December 2021. Methodology: Adults of age ≥18 years, admitted in amputee ward of AFIRM with lower limb amputation (traumatic or non-traumatic, unilateral or bilateral, new or follow up cases) were included in the study. All patients were undergoing DEXA scan for the first time since amputation. Patients were divided into 3 groups: transtibial amputation (TTA), transfemoral amputation (TFA) and ankle/foot amputation groups. Z-scores were documented for lumbar spine (L1-L4) and neck of femur (NOF). Z-scores at NOF were documented on amputated as well as non-amputated sides. Results: A total of 47 patients participated in the study. All were male. Mean age of patients was 30.8 ± 7.1 years (Range: 21-48 years). Majority of the patients (n=28, 59.6%) had left lower limb amputation. Out of 47 patients, TTA group comprised of 37 (78.7%) patients, TFA group comprised of 3 (6.4%) and ankle/foot group comprised of 5 (10.7 %) patients. Independent sample t-test was applied to determine the difference in Z-scores at NOF between amputated and non-amputated side in TTA group and result was statistically significant (p <0.001). Conclusion: A significant number of lower limb amputees suffer from reduced BMD. This is the well identified risk factor for NOF / hip fractures. Health care professionals must understand the significance of identifying amputees with low BMD.