![]() ![]() TBI patients (mild, moderate, or severe) with brain edema were eight times as likely to die compared to TBI patients without edema and surprisingly, were five times as likely to die for mild TBI-related edema ( 4). annually and approximately 22% die within the first 5 years after suffering a TBI. ![]() Per the CDC, there are over 50,000 deaths in the U.S. The clinical severity of TBI has been associated with an increased risk for mortality. This review will discuss the consequences that TBI on the skeleton and its possible mechanisms. In fact, TBI is the beginning of an ongoing, possibly lifelong, process that impacts multiple organ systems and bone that is proximal or distal to the site of injury. Individuals who have suffered mild TBI, or concussions, report adverse effects resulting from the TBI(s) months later ( 3) due to the rotational stress caused by head movement. Symptoms can range from mild concussions, with symptoms lasting from seconds, to more severe injuries with symptoms lasting years or even death. TBI may be classified based on severity as mild, moderate, or severe and location of injury and time of lost consciousness ( 2). Many statistics do not account for individuals who have not reported an injury or received medical care, and disabilities may be significantly higher, often with long-term consequences. Significant proportions of survivors require hospital care, extended rehabilitation, and may have long-term physical, cognitive, and psychological disorders. ![]() experience a TBI annually ( 1), and it is a major cause of death and disability worldwide, especially in children and young adults. TBI can lead to a series of physical, cognitive, social, emotional, and behavioral impairments ( 1) and is the leading cause of death and disability in both combat and civilian populations. Traumatic brain injury (TBI) is the disruption of brain activity due to an external force or violent blow to the head. This review will discuss the long-term consequences of TBI on the skeletal system and TBI-induced signaling pathways that contribute to the formation of ectopic bone, altered fracture healing, and reduced bone mass. Recent studies also suggest that the disruption of endocrine factors and neuropeptides caused by TBI may induce adverse skeletal effects. TBI has also been found to induce the formation of heterotopic ossification and increased callus formation at sites of muscle or fracture injury through increased vascularization and activation of systemic factors. Research from animal models suggests that TBI may exacerbate the activation and inactivation of molecular pathways leading to changes in both osteogenesis and bone destruction. Accordingly, many TBI patients have also presented with hormonal dysfunction, increased skeletal fragility, and increased risk of skeletal diseases. Also, the concept that hormonal signals and neural circuits that originate in the hypothalamus play key roles in regulating skeletal system is gaining recognition based on recent mouse genetic studies. It is only in recent years that there is growing awareness that TBI even in its milder form poses long-term health consequences to not only the brain but to other organ systems. Traumatic brain injury (TBI) leads to long-term cognitive, behavioral, affective deficits, and increase neurodegenerative diseases. 3Department of Orthopedic Surgery, Loma Linda University, Loma Linda, CA, United States. ![]() 2Department of Medicine, Loma Linda University, Loma Linda, CA, United States.1Musculoskeletal Disease Center, VA Loma Linda Healthcare System, Loma Linda, CA, United States.Bajwa 1 Chandrasekhar Kesavan 1,2 Subburaman Mohan 1,2,3* ![]()
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