Spinal Cord (1996) 34, 736–741; doi:10.1038/sc.1996.134

Ultrasound bone densitometry and dual energy X-ray absorptiometry in patients with spinal cord injury: a cross-sectional study

Y W Chow1, C Inman2, P Pollintine1, C A Sharp1, M J Haddaway1, W El Masry2 and M W J Davie1

  1. 1Charles Salt Research Centre, Robert Jones and Agnes Hunt Orthopaedic and District Hospital NHS Trust, Oswestry, Shropshire SY10 7AG, UK
  2. 2Midlands Centre for Spinal Injuries, Robert Jones and Agnes Hunt Orthopaedic and District Hospital NHS Trust, Oswestry, Shropshire SY10 7AG, UK

Correspondence: YW Chow, PhD, Charles Salt Research Centre, Robert Jones and Agnes Hunt Orthopaedic and District Hospital NHS Trust, Oswestry, Shropshire SY10 7AG, UK



Bone is lost following spinal cord injury (SCI) and in the long-term may become osteopenic and liable to fracture. Two non-invasive techniques, ultrasound bone densitometry (USBD) and dual energy X-ray absorptiometry (DXA), have been applied to monitor bone changes after spinal injury. 31 SCI patients were scanned using an ultrasound bone densitometer, to give measurements of speed of sound (SOS), broadband ultrasound attenuation (BUA) and 'stiffness'. The time since injury of these patients ranged between 5 weeks to 36 years with a mean of 5.87±10.21 years. Ultrasonic properties at the calcaneus of these patients were significantly lower than the healthy reference population, and a rapid decline in ultrasound properties occurred in the first 3 months. The fall continued up to 54 months but at a slower rate. The normal linear relationship between SOS and BUA was not altered by SCI. Eighteen patients had DXA measurements at the lumbar spine and the right proximal femur. Bone mineral density (BMD) at the femoral neck was significantly lower than the normal reference population (P<0.05). SOS and 'stiffness' correlated significantly with BMD at the lumbar spine, Ward's triangle, the femoral neck, the greater trochan ter and the intertrochanteric site (P<0.05). BUA correlated significantly at all these sites with the exception of the trochanter. A negative correlation was found between the ultrasonic properties at the calcaneus and BMD at the lumbar spine which is in contrast to the positive relationship in normal subjects. There was a tendency for BMD to increase at the lumbar spine after the first 12 months after injury, although this trend was not significant overall. The 'stiffness' at the calcaneus and BMD at the femoral neck were lower than the reference population following 12 months since injury. These results show that bone deficit at the calcaneus occurs rapidly and to a severe degree after SCI, and that ultrasound has an important role to play in the assessment of bone status in these patients.


spinal cord injury; ultrasound; dual energy X-ray absorptiometry; bone mineral density; speed of sound; broadband ultrasound attenuation



  1. Claus-Walker J, Spencer W A, Carter R E, Halstead L S. Bone metabolism in quadriplegia: dissociation between calciuria and hydroxyprolinuria. Archives of Physical Medicine & Rehabilitation 1975; 56: 327–332.
  2. Biering-Sørensen F, Bohr H, Schaadt O P. Bone mineral content of the lumbar spine and lower extremities years after spinal cord lesion. Paraplegia 1988; 26: 293–301. | PubMed |
  3. Biering-Sørensen F, Bohr H H, Schaadt O P. Longitudinal study of bone mineral content in the lumbar spine, the forearm and the lower extremities after spinal cord injury. Euro J Clin Invest 1990; 20: 330–335. | Article
  4. Garland D E et al. Osteoporosis after spinal cord injury. Journal of Orthopaedic Research 1992; 10: 371–378. | Article | PubMed
  5. Ingram R R, Suman R K, Freeman P A. Lower limb fractures in the chronic spinal cord injured patient. Paraplegia 1989; 27: 133–139. | PubMed | ISI | ChemPort |
  6. Haddaway M J, Davie M W J, McCall I W. Bone mineral density in healthy normal women and reproducibility of measurements in spine and hip using dual energy X-ray absorptiometry. Br J Radiol 1992; 65: 213–217. | Article | PubMed | ChemPort |
  7. Herd R J et al. Measurement of postmenopausal bone loss with a new contact ultrasound system. Calcif Tissue Int 1993; 53: 153–157. | Article | PubMed
  8. Langton C M, Palmer S B, Porter R W. The measurement of broadband ultrasound attenuation in cancellous bone. Eng Med 1984; 13: 89–91. | Article | PubMed
  9. Mautalen C et al. Ultrasound and dual X-ray absorptiometry densitometry in woman with hip fracture. Calcif Tissue Int 1995; 57: 165–168. | Article | PubMed
  10. Porter R W, Miller C G, Grainger D, Palmer S B. Prediction of hip fracture in elderly women: a prospective study. Br Med J 1990; 301: 638–641. | Article
  11. Waud C E, Lew R, Baren T D. The relationship between ultrasound and densitometric measurements of bone mass at the calcaneus in woman. Calcif Tissue Int 1992; 51: 415–418. | Article | PubMed
  12. Lees B, Stevenson J C. Prelininary evaluation of a new ultrasound bone densitometer. Calcified Tissue Int 1993; 53: 149–152. | Article
  13. Cassar-Pullicino V N et al. Sonographic diagnosis of heterotopic bone formation in spinal injury patients. Paraplegia 1993; 31: 40–50. | PubMed |
  14. Chappard D et al. Effect of tiludronate on bone loss in paraplegic patients. Journal of Bone and Mineral Research 1995; 10(1): 112–118.
  15. Marshall M J, Holt I, Davie M W J. Normal and therapeutic regulation of bone resorption. J Orthop Res 1995; 8: 63–68.
  16. Leslie W D, Nance P W. Dissociated hip and spine demineralisation: a specific finding in spinal cord injury. Arch Phys Med Rehabil 1993; 74: 960–964. | PubMed | ISI | ChemPort |
  17. Evans S F, Davie M W J. Low and conventional dose transdermal oestradiol are equally effective at preventing bone loss in spine and femur at all post-menopausal ages. Clin Endocrinol 1996; 44: 79–84. | Article
  18. Salmone L M, Krall E A, Harris S, Dawson-Hughes B. Comparison of broadband ultrasound attenuation to single X-ray absorptiometry measurements at the calcaneus in postmenopausal women. Calcif Tissue Int 1993; 54: 87–90. | Article
  19. Palacios S, Menéndez C, Calderón J, Rubio S. Spine and femur density and broadband ultrasound attenuation of the calcaneus in normal Spanish women. Calcif Tissue Int 1992; 52: 99–102. | Article
  20. Minaire P et al. Quantitative histological data on disuse osteoporosis: comparison with biological data. Calcif Tiss Res 1974; 17: 57–73. | Article
  21. Uhthoff H K, Jaworski Z F G. Bone loss in response to long term immobilisation. J Bone Joint Surg 1978: 60B: 420–429.
  22. Skerry T M, Lanyon L E. Immobilisation induced bone loss in sheep is not modulated by calcitonin treatment. Bone 1993: 14(3): 511–516.
  23. Sharp C A et al. Bone turnover after spinal cord injury. Bone 1995; 16: 186S.
  24. Uebelhart D et al. Early modifications of biochemical markers of bone metabolism in spinal cord injury patients: a preliminary study. Scand J Rehab Med 1994; 26: 197–202. | ISI | ChemPort |