Osteoporosis in the lower extremities in chronic spinal cord injury

• Published in: Spinal cord 2020-04, Vol.58 (4), p.441-448
• Main Authors: Frotzler, Angela, Krebs, Jörg, Göhring, Andrea, Hartmann, Kathrin, Tesini, Stefanie, Lippuner, Kurt
• Format: Article
• Language: English
• Subjects: 631/443/811; 692/698/1671/63; Absorptiometry, Photon; Adult; Anatomy; Biomedical and Life Sciences; Biomedical materials; Biomedicine; Bone Density; Bone loss; Bone mineral density; Chronic Disease; Computed tomography; Cross-Sectional Studies; Densitometers; Densitometry; Diaphysis; Dual energy X-ray absorptiometry; Epiphysis; Extremities; Female; Femur; Fractures; Hip; Human Physiology; Humans; Long bone; Male; Men; Middle Aged; Neurochemistry; Neuropsychology; Neurosciences; Osteoporosis; Osteoporosis - diagnostic imaging; Osteoporosis - etiology; Osteoporotic Fractures - etiology; Parameters; Rehabilitation; Sex Factors; Spinal cord injuries; Spinal Cord Injuries - complications; Surgical implants; Tomography, X-Ray Computed; Women
• ISSN: 1362-4393; 1476-5624
• DOI: 10.1038/s41393-019-0383-0

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 able-bodied 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.