Osteoporosis in the lower extremities in chronic spinal cord injury

Abstract

Study design Cross-sectional study. Objectives To investigate the effect of chronic motor complete spinal cord injury (SCI) and sex on bone densitometry parameters of the hip, femoral neck, tibial epiphysis, and diaphysis and on long bone fractures. Setting SCI rehabilitation center. Methods Women and men with long-term (≥7 years) motor complete SCI were compared with able-bodied women and men. Dual-energy X-ray absorptiometry was used to assess bone densitometry parameters at the hip and femoral neck, whereas peripheral quantitative computed tomography was used for the tibial epiphysis and diaphysis. Results The data of 18 women and 25 men with SCI with a mean age of 54.7 ± 12.4 and 53.5 ± 8.6 years, respectively, were analyzed. As reference groups, 74 able-bodied women and 46 men with a mean age of 51.0 ± 13.1 and 50.9 ± 11.2 years were evaluated. Most bone densitometry values were significantly (p ≤ 0.033) lower in the SCI compared with the reference groups, including total bone mineral density at the distal tibial epiphysis (−58.0% in SCI women and −53.6% in SCI men). Fracture rates per 100 patient-years were 3.17 and 2.66 in women and men with SCI compared with 0.85 and 0.21 in ablebodied women and men, respectively. Conclusions Compared with able-bodied women and men, individuals with chronic motor complete SCI showed considerably lower bone densitometry values and a higher historical fracture rate. These findings support the need for preventative and therapeutic strategies against bone loss in individuals with SCI.

Knowledge Level and Awareness About Osteoporosis in Patients with Spinal Cord Injury

“…SKY'den sonraki ilk 6 ayda, etkilenen trabeküler ve kortikal kemik bölgelerinde sırasıyla her ay %2 ve %4 oranında kemik kitlesi azalır (13,14). Çoğu kemik kaybı nörolojik yaralanmayı takip eden ilk yılda meydana gelir ve sonraki yıllarda da devam eder (10). Bununla birlikte, immobilizasyonla ilgili uzun kemik yüklenmesi eksikliğinin ötesinde, SKY ile ilişkili kemik yoğunluğu kaybının çoklu mekanizmaları tam olarak anlaşılamamıştır (15).…”

“…Bu kesitsel çalışmaya OP açısından riskli grupta bulunan 18 yaş üstü, ardışık 70 hasta (53 erkek, 17 kadın) alındı. Risk grubu en az 6 ay önce travmatik SKY tanılı hastalığına bağlı yürüme güçlüğü olan hastalar olarak belirlendi (10). Hastaların yaşı, cinsiyeti, vücut kitle indeksi, eğitim düzeyleri, hastalık süresi, yaralanma seviyesi, komplet/inkomplet lezyon varlığı, fonksiyonel ambulasyon skalası not edildi.…”

Clinical guidelines for neurorestorative therapies in spinal cord injury (2021 China version)

“…In SCI, there is interruption of the ascending and descending neural tracts that connect the brain to the sensory and autonomic innervation of bone. Neurogenic osteoporosis after SCI is strikingly severe [188]. Immobilization, bone denervation, and hormonal and metabolic changes contribute to SCI-induced bone loss [189].…”

“…Immobilization, bone denervation, and hormonal and metabolic changes contribute to SCI-induced bone loss [189]. Approximately one-half of SCI patients sustain a long bone fracture after injury [188]. Furthermore, neurogenic osteoporosis after SCI causes difficulty in bone healing after fracture [187].…”

“…Furthermore, neurogenic osteoporosis after SCI causes difficulty in bone healing after fracture [187]. However, at present, there are no evidencebased recommendations regarding prevention and treatment of osteoporosis after SCI [188][189][190]. Nonetheless, comprehensive neurorestorative strategies may provide some benefit in treating neurogenic osteoporosis, maintaining skeletal health, and promoting fracture healing.…”