300 Section - Effects of Botulinum Toxin on Bone Health in Upper Motor Neuron Syndromes: A Scoping Review

Tuesday, May 19, 2026

6:00 PM - 7:30 PM PT

Presenting Author/Autor expositor(s)

NM

Neelam Minhas, MD

Fellow
University of Western Ontario
London, Ontario, Canada

Co-Author/Coautor(s)

JF

Jamie Fleet, MD

Physician
University of Western Ontario
London, Ontario, Canada
AW

Arpana Wadhwani, BS

Medical Student
University of Western Ontario
London, Ontario, Canada

Objectives : Botulinum toxin has revolutionalized spasticity management, however can be associated with downstream consequences. Whether botulinum toxin injections affect bone quality or quantity within humans is not well known. Emerging research has focused on effects of bone health after botulinum toxin injections within animal models primarily and more recently within humans with temporomandibular dysfunction. Findings suggest reduced bone volume, trabecular density, and changes to the microarchitecture (Tang et al. 2021; Owen 2022). Given the repeated use of botulinum toxin injections in patients with spasticity, we aimed to review the literature on the effect of intramuscular botulinum toxin injections on bone density in humans with upper motor neuron syndromes.

Design: The study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR) checklist. Inclusion criteria and exclusion criteria were specified. SCOPUS, CINAHL/EBSCO, APAPsychInfo, EMBASE, Clinical Trials, MEDLINE/PubMed and Google Scholar were reviewed from database inception to July 2025. Articles were assessed within COVIDENCE by two screeners, and the third investigator resolved disagreements, with data extracted using a pre-specified tool.

Results: Among 3, 131 studies reviewed, 6 studies were assessed for full-text reviews. Only one study met the inclusion criteria and was a longitudinal observational prospective study.

Conclusion: There is scarce evidence on the effect of botulinum toxin on bone health when used for spasticity in those with upper motor neuron syndromes. Evidence in animal studies and those with temporomandibular dysfunction suggest that injections affect both muscle health and bone health over time (Tang et al. 2021; Owen 2022). Given the frequency of injections and dosages that can be used over a patients life span, this is an area which needs to be explored. Further research is needed to assess the long-and short-term implications of botulinum toxin injections on bone health in this population.