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Fractures and musculoskeletal ailments in persons 20+ years after a traumatic spinal cord injury in Norway

Spinal Cord Series and Casesvolume 4, Article number: 76 (2018) | Download Citation

Abstract

Study design

Cross-sectional study.

Objectives

To gain insights into fracture rate and musculoskeletal ailments among Norwegians with a spinal cord injury (SCI) acquired more than 20 years ago.

Settings

Sunnaas Hospital, Nesoddtangen, Norway

Methods

165 persons with SCI were interviewed in 2004–2005 by questionnaires and clinical examination. Descriptive statistics and a logistic regression analysis were performed to identify variables associated with bone fractures and musculoskeletal ailments.

Results

Around half of the participants experienced a fracture after injury and excessive use of alcohol increased the odds (OR 0.09; CI 0.01–0.74) of suffering a post-injury fracture (p = 0.03). Sixty percent experienced shoulder ailments after the SCI and the use of orthosis to the knee and hip increased the odds (OR 4.4; CI 1.4–13) of experiencing shoulder ailment (p = 0.01).

Conclusion

Around half of the 165 participants reported to have suffered a fracture and over 100 to experience musculoskeletal ailment 20 years after injury. We suggest that prevention strategies and symptom management must be embedded in follow-up visits after SCI.

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References

  1. 1.

    Castro MJ, Apple DF Jr, Hillegass EA, Dudley GA. Influence of complete spinal cord injury on skeletal muscle cross-sectional area within the first 6 months of injury. Eur J Appl Physiol Occup Physiol. 1999;80:373–8.

  2. 2.

    Jiang SD, Jiang LS, Dai LY. Mechanisms of osteoporosis in spinal cord injury. Clin Endocrinol. 2006;65:555–65.

  3. 3.

    Edwards WB, Schnitzer TJ. Bone imaging and fracture risk after spinal cord injury. Curr Osteoporos Rep. 2015;13:310–7.

  4. 4.

    Troy KL, Morse LR. Measurement of bone: diagnosis of SCI-induced osteoporosis and fracture risk prediction. Top Spinal Cord Inj Rehabil. 2015;21:267–74.

  5. 5.

    Cervinka T, Lynch CL, Giangregorio L, Adachi JD, Papaioannou A, Thabane L, et al. Agreement between fragility fracture risk assessment algorithms as applied to adults with chronic spinal cord injury. Spinal Cord. 2017;55:985–93.

  6. 6.

    Cirnigliaro CM, Myslinski MJ, La Fountaine MF, Kirshblum SC, Forrest GF, Bauman WA. Bone loss at the distal femur and proximal tibia in persons with spinal cord injury: imaging approaches, risk of fracture, and potential treatment options. Osteoporos Int. 2017;28:747–65.

  7. 7.

    Carbone LD, Chin AS, Burns SP, Svircev JN, Hoenig H, Heggeness M, et al. Mortality after lower extremity fractures in men with spinal cord injury. J Bone Mineral Res. 2014;29:432–9.

  8. 8.

    Bauman WA, Cardozo CP. Osteoporosis in individuals with spinal cord injury. PM R. 2015;7:188–201.

  9. 9.

    Morse LR, Battaglino RA, Stolzmann KL, Hallett LD, Waddimba A, Gagnon D, et al. Osteoporotic fractures and hospitalization risk in chronic spinal cord injury. Osteoporos Int. 2009;20:385–92.

  10. 10.

    Lidal IB, Veenstra M, Hjeltnes N, Biering-Sorensen F. Health-related quality of life in persons with long-standing spinal cord injury. Spinal Cord. 2008;46:710–5.

  11. 11.

    Jakimovska VM, Kostovski E, Biering-Sorensen F, Lidal IB. Psychological distress and user experiences with health care provision in persons living with spinal cord injury for more than 20 years. Spinal Cord. 2017;55:864–9.

  12. 12.

    Biering-Sorensen F, DeVivo MJ, Charlifue S, Chen Y, New PW, Noonan V, et al. International Spinal Cord Injury Core Data Set (version 2.0)-including standardization of reporting. Spinal Cord. 2017;55:759–64.

  13. 13.

    Kirshblum SC, Burns SP, Biering-Sorensen F, Donovan W, Graves DE, Jha A, et al. International standards for neurological classification of spinal cord injury (revised 2011). J Spinal Cord Med. 2011;34:535–46.

  14. 14.

    DeVivo MJ, Biering-Sorensen F, New P, Chen Y. Standardization of data analysis and reporting of results from the International Spinal Cord Injury Core Data Set. Spinal Cord. 2011;49:596–9.

  15. 15.

    Lidal VMJEKFB-SIB. Musculoskeletal issues, mobility aids and assistance in persons 20+years after a traumatic spinal cord injury in Norway. 2017.

  16. 16.

    Pripp AH, Dahl OE. The population attributable risk of nutrition and lifestyle on hip fractures. Hip Int. 2015;25:277–81.

  17. 17.

    Werhagen L, Aito S, Tucci L, Strayer J, Hultling C. 25 years or more after spinal cord injury: clinical conditions of individuals in the Florence and Stockholm areas. Spinal Cord. 2012;50:243–6.

  18. 18.

    Dionyssiotis Y. Spinal cord injury-related bone impairment and fractures: an update on epidemiology and physiopathological mechanisms. J Musculoskelet Neuron Interact. 2011;11:257–65.

  19. 19.

    McKinley WO, Jackson AB, Cardenas DD, DeVivo MJ. Long-term medical complications after traumatic spinal cord injury: a regional model systems analysis. Arch Phys Med Rehabil. 1999;80:1402–10.

  20. 20.

    Zehnder Y, Luthi M, Michel D, Knecht H, Perrelet R, Neto I, et al. Long-term changes in bone metabolism, bone mineral density, quantitative ultrasound parameters, and fracture incidence after spinal cord injury: a cross-sectional observational study in 100 paraplegic men. Osteoporos Int. 2004;15:180–9.

  21. 21.

    Vestergaard P, Krogh K, Rejnmark L, Mosekilde L. Fracture rates and risk factors for fractures in patients with spinal cord injury. Spinal Cord. 1998;36:790–6.

  22. 22.

    Bossuyt FM, Arnet U, Brinkhof MWG, Eriks-Hoogland I, Lay V, Muller R, et al. Shoulder pain in the Swiss spinal cord injury community: prevalence and associated factors. Disabil Rehabil. 2018;40:798–805.

  23. 23.

    Paolucci S, Martinuzzi A, Scivoletto G, Smania N, Solaro C, Aprile I, et al. Assessing and treating pain associated with stroke, multiple sclerosis, cerebral palsy, spinal cord injury and spasticity. Evidence and recommendations from the Italian Consensus Conference on Pain in Neurorehabilitation. Eur J Phys Rehabil Med. 2016;52:827–40.

  24. 24.

    Michailidou C, Marston L, De Souza LH, Sutherland I. A systematic review of the prevalence of musculoskeletal pain, back and low back pain in people with spinal cord injury. Disabil Rehabil. 2014;36:705–15.

  25. 25.

    Hardin EC, Kobetic R, Triolo RJ. Ambulation and spinal cord injury. Phys Med Rehabil Clin N Am. 2013;24:355–70.

  26. 26.

    Lidal IB, Jensen AE, Larsen TW, Stanghelle JK. Fatigue in persons who have lived with spinal cord injury for>20 years. Spinal Cord. 2013;51:103–8.

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Acknowledgements

We want to thank the study participants, the Norwegian Association of the Disabled, Norwegian Association for Spinal Injuries, Norwegian Foundation for Health and Rehabilitation (EXTRA), the Sunnaas Rehabilitation Hospital, Eastern Norway Health Authority (Helse Øst), and the QUOTA program for contributing financial support to the project.

Author information

Affiliations

  1. Sunnaas Rehabilitation Hospital, Nesoddtangen, Norway

    • Vesna Miloshevska Jakimovska
    • , Emil Kostovski
    •  & Ingeborg Beate Lidal
  2. Faculty of Medicine, University of Oslo, Oslo, Norway

    • Vesna Miloshevska Jakimovska
    • , Emil Kostovski
    •  & Fin Biering-Sørensen
  3. Clinic for Spinal Cord Injuries, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark

    • Fin Biering-Sørensen

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Statements of ethics

We certify that all applicable institutional and governmental regulations concerning the ethical use of human volunteers were followed during the course of this research.

Conflict of interest

The authors declare that they have no conflict of interest.

Corresponding author

Correspondence to Vesna Miloshevska Jakimovska.

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DOI

https://doi.org/10.1038/s41394-018-0102-7