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 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.

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Acknowledgements

The authors thank Dr Dirk Lehnick for his assistance with the statistical analyses.

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Contributions

AF: conception and design, acquisition of data, analysis and interpretation of data, drafting of the manuscript, and approval of final version. JK: analysis and interpretation of data, drafting of the manuscript, approval of final version. AG: analysis and interpretation of data, drafting of the manuscript, approval of final version. KH: acquisition of data, revised the manuscript for important intellectual content, and approval of final version. ST: analysis and interpretation of data, revised the manuscript for important intellectual content, and approval of final version. KL: conception and design, supervision, analysis and interpretation of data, revised the manuscript for important intellectual content, and approval of final version

Corresponding author

Correspondence to Angela Frotzler.

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Ethical statement

This study had been approved by the Ethics Committee of Northwestern and Central Switzerland. All participants provided written informed consent before participation in the study. We certify that all applicable institutional and governmental regulations concerning the ethical use of human volunteers were followed during the course of this research.

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The authors declare that they have no conflict of interest.

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Frotzler, A., Krebs, J., Göhring, A. et al. Osteoporosis in the lower extremities in chronic spinal cord injury. Spinal Cord 58, 441–448 (2020). https://doi.org/10.1038/s41393-019-0383-0

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