Bone loss following spinal cord injury

Abstract

Objective: To evaluate the pattern of bone loss and its consequences in a group of spinal cord injured patients managed at the Spinal Unit-Royal Rehabilitation Centre (RRC)-King Hussein Medical Center (KHMC) and its correlation to level, extent of injury, age and time post injury. Method(s): The BMD was measured in a group of patients who sustained Spinal Cord Injury (SCI) before 1-31 years (mean duration of SCI 8.6 years) who completed their medical and rehabilitation program at Spinal Unit-(RRC) during the period July, 2003 to Dec, 2013. BMD was measured by DXA in the lumbar spine and femoral neck, patients were diagnosed to have osteoporosis according to WHO criteria and their fracture's risk was described from this score using published data. Their spinal injuries were classified according to American Spinal Injury Association (ASIA) criteria, ranging from A-D. Result(s): 55 patients were included in the study; there were 45 males and 10 females with male to female ratio (4.5:1). Their age ranged between 13 and 61 years (mean age 39.5 years). Bone loss indicated by low BMD revealed that femoral region is predominantly affected with relative preservation of the lumbar spine. Abnormal BMD values were detected in 83.6 % of subjects. A positive correlation was noticed between the time following the injury and the degree of osteoporosis. Individuals with complete injuries showed lower BMD values compared to those with incomplete lesions. No significant correlation was found regarding their age and gender. Conclusion(s): SCI subjects are at high risk of developing osteoporosis which can lead to significant morbidity, particularly lower extremity fractures without significant trauma. Prevention and early treatment of bone loss are an important goal to prevent additional functional impairment.