A Primary Care Provider's Guide to Bone Health in Spinal Cord-Related Paralysis

Individuals with spinal cord injury/disorder (SCI/D) are at high risk for developing secondary osteoporosis. Bone loss after neurologic injury is multifactorial and is dependent on the time from and extent of neurologic injury. Most bone loss occurs in the first year after complete motor paralysis, and fractures occur most commonly in the distal femur and proximal tibia (paraplegic fracture). Clinicians caring for individuals with spinal cord–related paralysis must maintain a high index of suspicion for fragility fractures and consider referral for surgical evaluation and management.

• 1
  Most bone loss occurs in the first year following neurologic injury and continues for years after.
• 2
  Spinal cord injury–related fractures occur most commonly around the knee (distal femur/proximal tibia).
• 3
  All adults with spinal cord injury resulting in permanent motor or sensory dysfunction should have a DXA (dual-energy x-ray absorptiometry) scan of the total hip, proximal tibia, and distal femur as soon as medically stable in order to diagnose osteoporosis, predict lower extremity fracture risk, and monitor response to therapy.