The Beneficial Effects of the Anabolic Steroid Oxandrolone in the Geriatric Burn

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The Beneficial Effects of the Anabolic Steroid Oxandrolone in the Geriatric Burn Population

Author(s): Robert Demling, MD; Leslie DeSanti, RN
Introduction

The geriatric patient, usually defined as being over 65 years of age, comprises an increasing percent of the major burn population.[1–3] This statistic will continue to increase as the aging population increases.

The high morbidity and mortality in the geriatric burn population is related to the presence of significant comorbid factors, many of which decrease lean body mass and body protein content.[1–5] Some of these comorbid factors cannot be significantly improved, such as cardiopulmonary disease. However, one major comorbid factor, which appears to be increasing in the elderly, is the presence of a degree of protein energy malnutrition (PEM),[6–9] prior to the burn injury. This factor leads to lost lean mass, impaired immune function, thinning of skin, muscle weakness, and impaired healing. The addition of the anabolic steroid agent oxandrolone to optimum nutrition has been shown to decrease the rate of lean mass loss and increase the rate of restoration of lost weight in the general burn patient population. Oxandrolone should be especially beneficial in patients with pre-existing PEM once nutrition has been implemented.[10,11] However, the efficacy and safety of this approach has not been defined for the geriatric burn population.

The purpose of this study was to determine the effect of the anabolic steroid oxandrolone in the geriatric burn population in a randomized prospective trial comparing standard of care versus standard care plus oxandrolone. Outcome variables measured included mortality, weight loss, nitrogen loss, and rate of wound healing, which are indicators of the status of the lean mass compartment. In addition, the authors wanted to assess length of stay, a marker of restoration of musculoskeletal function.

The authors studied burns of 10 to 30 percent of total body surface, as this population is at high risk for morbidity. A burn of 10 percent or more is a major burn, especially in the geriatric population. Larger burns, exceeding 30-percent total body surface (TBS), have extremely high mortality in this age group mainly due to cardiopulmonary failure and infection and were not studied. Many of these larger burn patients deteriorate within hours after injury.

Methods

Study protocol. All burn patients over 65 years of age admitted to the burn center from 1999 through 2001 were eligible for this randomized prospective study, which was approved by the Institutional Research Review Board. Total body surface burn was required to be in the range of 10 to 30 percent of TBS with at least one excision and grafting procedure required. Exclusion criteria were an elevated prostate screening antigen (PSA) in male patients or patients with a history of prostate carcinoma. Patients enrolled were randomized into a burn care alone group or burn care plus oxandrolone 10mg/twice a day group. Patients with an elevated creatinine had a creatinine clearance performed. A dose of 10mg of oxandrolone a day was used if creatinine clearance was less than 25 percent of normal for age. The study was continued until the patient was discharged or transferred to our rehabilitation center.

Oxandrolone was also discontinued if serum aspartate aminotransferase (AST) and/or alanine aminotransferase (ALT) exceeded three times normal values and remained elevated for over 72 hours in the absence of an identifiable cause. If values rapidly returned to normal, oxandrolone was re-instituted.

Nutritional assessment and support. An assessment of nutritional status on admission was performed, which included a nutritional history, a history of pre-burn unintentional weight loss, especially over the previous six months, physical findings of malnutrition, and a serum pre-albumin level drawn immediately on admission.

References:
References

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