Fracture rates and risk factors for fractures in patients with spinal cord injury

Abstract

Aim: To study fracture rates and risk factors for fractures in patients with spinal cord injuries. Material and methods: A self-administered questionnaire was mailed to 646 members of the Danish Paraplegic Association and 1000 randomly selected normal controls. 438 patients (309 males, 129 females, 67.8%) and 654 controls (332 males, 322 females, 65.4%) returned the questionnaire. Median age in patients was 42, range 10 ± 80 years, and in controls 43, range 19 ± 93 years (2p=0.25). Results: The crude fracture rate was 2% per year in patients and 1% per year in controls (RR=2.0, P50.001). Low-energy fractures were much more prominent in patients (19.0% of all fractures) than in controls (1.4%, P50.001). The fracture rate did not di er before the injury but increased after the injury to a constant level from the third year and forward. Fractures of the lower extremities were more prominent in patients than controls (femurs: RR=23.4, P50.001, lower legs: RR=5.2, P50.001, feet/toes: RR=2.4, P=0.006) while fractures of the forearms (P50.001) and clavicles (P=0.03) were absent among patients. Fractures were more frequent in female patients (RR=1.6, P=0.008) and in male patients with a family history of fractures (RR=2.0, P=0.004). Conclusions: Low-energy fractures especially of the lower extremities are frequent in spinal cord injury patients and especially among female patients. The forearms seem protected from fractures.

Physiological effects of lower extremity functional electrical stimulation in early spinal cord injury: lack of efficacy to prevent bone loss

“…However, although physiologically significant, it is unclear whether small focal BMD increments in response to FES are clinically relevant to fracture prevention. Studies of FES effects upon other bone strength properties (bone size, geometry, architecture) and clinical end points such as SCI fracture frequency and distribution [43][44][45][46] may resolve this question.…”

An evaluation of the muscle-bone unit theory among individuals with chronic spinal cord injury

“…1 There is a rapid decline in bone mineral density (BMD) of the periarticular hip and knee regions within 12-18 months post motor complete SCI (AIS A-D) of 3-4% per month, 2 thereby placing individuals with chronic SCI at a high risk for developing lower-extremity fragility fractures during low-trauma events (that is, during a transfer or rolling over in bed). Fragility fractures after SCI can lead to increased morbidity, decreased functional mobility, and increased attendant care and healthcare costs.…”

The course of bone mineral density and biochemical markers of bone turnover in early postmenopausal spinal cord-lesioned females

“…6,7 The overall fracture rate is 2% per year in the Danish SCL population compared to 1% per year in healthy controls. 8 In the same study, the relative risk of femur fractures in the SCL population was 23 times higher than for the controls.…”