Increase in Bone Mineral Density of the Amputated-Side Femur Following High-Impact Training in a Young Transtibial Amputee: A Case Report

Loss of bone mineral density (BMD) in the amputated limb is a well-documented complication after lower limb amputation, predisposing patients to osteoporosis and fragility fractures. Exercise interventions have been recommended to mitigate this decline, but to date no clinical reports have demonstrated an actual increase in hip BMD following amputation. We describe a young male dockworker who underwent transtibial amputation after severe occupational trauma. A structured rehabilitation program incorporating high-impact and resistance training was delivered for four months during hospitalization, followed by continued self-directed exercise after discharge. Serial dual-energy X-ray absorptiometry (DXA) scans over three years revealed progressive gains in amputated-side hip BMD, with final measurements showing a 17.4-24.3% increase from baseline. This appears to be the first longitudinally documented case of improved hip BMD in an amputated limb following structured rehabilitation with high-impact exercise. The program closely paralleled recent expert recommendations on exercise prescription for amputees, underscoring the potential of targeted progressive loading to preserve skeletal health. However, the relative contribution of exercise intensity versus other factors remains uncertain, and further studies are needed to establish dose-response relationships and generalizability.