Detection and Treatment of Sublesional Osteoporosis Among Patients with Chronic Spinal Cord Injury

Craven, B. Catharine; Robertson, Daniel; McGillivray,; Adachi,

doi:10.1310/sci1404-1

Cited by 46 publications

(31 citation statements)

References 71 publications

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“…In fact, we are aware of some 25 reviews that have discussed these topics to some degree in the past decade (for comprehensive reviews see: [3,[13][14][15][16][17][18][19][20][21]). Despite the fact that bone loss after SCI is a well-established and highly discussed phenomenon, little progress has been made to reduce bone loss and the incidence of fracture observed after SCI, especially when compared to advancements made in postmenopausal and age-related osteoporosis [22].…”

Section: Introductionmentioning

confidence: 99%

Bone Imaging and Fracture Risk after Spinal Cord Injury

Edwards

Schnitzer²

2015

Curr Osteoporos Rep

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Spinal cord injury (SCI) is characterized by marked bone loss and an increased risk of fracture with high complication rate. Recent research based on advanced imaging analysis, including quantitative computed tomography (QCT) and patient-specific finite element (FE) modeling, has provided new and important insights into the magnitude and temporal pattern of bone loss, as well as the associated changes to bone structure and strength, following SCI. This work has illustrated the importance of early therapeutic treatment to prevent bone loss after SCI and may someday serve as the basis for a clinical fracture risk assessment tool for the SCI population. This review provides an update on the epidemiology of fracture after SCI and discusses new findings and significant developments related to bone loss and fracture risk assessment in the SCI population based on QCT analysis and patient-specific FE modeling.

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Section: Introductionmentioning

confidence: 99%

Bone Imaging and Fracture Risk after Spinal Cord Injury

Edwards

Schnitzer²

2015

Curr Osteoporos Rep

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“…At this time, the available evidence supports that the best use of knee software in clinical investigations is to monitor potential changes from mechanical and/or pharmacological interventions. Along with SCI-specific clinical risk factors [53], this information can guide clinical treatment options and/or research interventions associated with the application of substantial mechanical forces during supervised therapeutic sessions or exercise training routines. Because of the scarcity of literature that defines a given DXA-derived aBMD value, as well as the absence of a well-validated fracture threshold at the DF and PT, clinicians should consider collecting, if feasible, additional trabecular microarchitecture and bone geometry measures from CT or magnetic resonance imaging (MRI) to better identify persons who are at heightened risk of fragility fracture.…”

Section: Dxa Software For the Knee Regionmentioning

confidence: 99%

“…In a review of proposed paradigms to diagnose and treat sublesional osteoporosis, Craven et al [53] summarized the risk factors associated with fragility fracture based on the available literature as follows: SCI occurred <16 years of age [77], paraplegia [78], excessive alcohol consumption after SCI (>5 servings per day) [9], completeness of injury (American Spinal Injury Association Impairment Scale (AIS) A and B) [11], family history of fragility fracture [76], female [30], previous fragility fracture [30], low BMI (<19 kg/m 2 ) [79], and duration of injury ≥10 years [30]. While it is true that larger prospective cohort studies are needed to identify the extent to which these risk factors are independent of aBMD, physicians and therapists should utilize these SCI-specific clinical risk factors along with aBMD of the DF and PT to guide treatment throughout the chronic phase of injury.…”

Section: Low Bmd and Fragility Fracture In Scimentioning

confidence: 99%

Bone loss at the distal femur and proximal tibia in persons with spinal cord injury: imaging approaches, risk of fracture, and potential treatment options

et al. 2016

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Persons with spinal cord injury (SCI) undergo immediate unloading of the skeleton and, as a result, have severe bone loss below the level of lesion associated with increased risk of long-bone fractures. The pattern of bone loss in individuals with SCI differs from other forms of secondary osteoporosis because the skeleton above the level of lesion remains unaffected, while marked bone loss occurs in the regions of neurological impairment. Striking demineralization of the trabecular epiphyses of the distal femur (supracondylar) and proximal tibia occurs, with the knee region being highly vulnerable to fracture because many accidents occur while sitting in a wheelchair, making the knee region the first point of contact to any applied force. To quantify bone mineral density (BMD) at the knee, dual energy x-ray absorptiometry (DXA) and/or computed tomography (CT) bone densitometry are routinely employed in the clinical and research settings. A detailed review of imaging methods to acquire and quantify BMD at the distal femur and proximal tibia has not been performed to date but, if available, would serve as a reference for clinicians and researchers. This article will discuss the risk of fracture at the knee in persons with SCI, imaging methods to acquire and quantify BMD at the distal femur and proximal tibia, and treatment options available for prophylaxis against or reversal of osteoporosis in individuals with SCI.

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“…Fragility fractures result from low force injuries insufficient to fracture normal bone. 39,40 Common etiologies of fragility fractures after SCI include leg torsion during transfers or rolling in bed, or falling to the floor from a wheelchair or commode on a flexed knee. Compression fractures of vertebral bodies should be considered as fragility fractures, in the absence of reported trauma.…”

Section: Fracture(s) Since the Spinal Cord Lesionmentioning

confidence: 99%

International spinal cord injury musculoskeletal basic data set

et al. 2012

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Objectives: To develop an International Spinal Cord Injury (SCI) Musculoskeletal Basic Data Set as part of the International SCI Data Sets to facilitate consistent collection and reporting of basic musculoskeletal findings in the SCI population. Setting: International. Methods: A first draft of an SCI Musculoskeletal Basic Data Set was developed by an international working group. This was reviewed by many different organizations, societies and individuals over 9 months. Revised versions were created successively. Results: The final version of the International SCI Musculoskeletal Basic Data Set contains questions on neuro-musculoskeletal history before spinal cord lesion; presence of spasticity/spasms; treatment for spasticity within the last 4 weeks; fracture(s) since the spinal cord lesion; heterotopic ossification; contracture; the location of degenerative neuromuscular and skeletal changes due to overuse after SCI; SCI-related neuromuscular scoliosis; the method(s) used to determine the presence of neuromuscular scoliosis; surgical treatment of the scoliosis; other musculoskeletal problems; if any of the musculoskeletal challenges above interfere with activities of daily living. Instructions for data collection and the data collection form are freely available on the International Spinal Cord Society (ISCoS) website (www.iscos.org.uk). Conclusion: The International SCI Musculoskeletal Basic Data Set will facilitate consistent collection and reporting of basic musculoskeletal findings in the SCI population.

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Detection and Treatment of Sublesional Osteoporosis Among Patients with Chronic Spinal Cord Injury

Cited by 46 publications

References 71 publications

Bone Imaging and Fracture Risk after Spinal Cord Injury

Bone Imaging and Fracture Risk after Spinal Cord Injury

Bone loss at the distal femur and proximal tibia in persons with spinal cord injury: imaging approaches, risk of fracture, and potential treatment options

International spinal cord injury musculoskeletal basic data set

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