Characteristics Associated with Bone Loss after Spinal Cord Injury: Implications for Hip Region Vulnerability

Endocrinol Metab, 2023 · DOI: https://doi.org/10.3803/EnM.2023.1795 · Published: December 1, 2023

Spinal Cord Injury Endocrinology Rehabilitation

Simple Explanation

Spinal cord injury (SCI) can lead to motor or sensory issues, reducing movement and physical activity. This can disrupt bone metabolism, increasing bone loss below the injury site and raising fracture risk. Bone loss after SCI can lead to increased risk of fractures, especially in the lower limbs, which can result in lengthy hospital stays and increased premature mortality. This study aimed to identify SCI-related risk factors for bone loss by comparing bone mineral density (BMD) between men with SCI and matched community-dwelling men.

Study Duration

2008 to 2020

Participants

113 men with SCI and 113 community-dwelling men

Evidence Level

Not specified

Key Findings

1
Men with SCI had significantly lower bone mineral density in the hip region compared to community-dwelling men, but lumbar spine T-scores did not differ significantly.
2
Participants with paraplegia showed significantly higher hip region Z-scores than those with tetraplegia, indicating a protective effect of paraplegia in the hip region.
3
Motor-incomplete SCI was associated with relatively preserved Z-scores of the hip region compared to the lumbar region.

Research Summary

This study compared bone mineral density (BMD) in middle-aged men with spinal cord injury (SCI) to community-dwelling men, finding lower hip BMD in the SCI group. Paraplegia and motor-incomplete SCI were identified as protective factors against bone loss in the hip region among men with SCI. Skeletal muscle percentage showed a positive correlation with femoral neck BMD in men with SCI, while body fat percentage showed a negative correlation.

Practical Implications

Increased Fracture Risk Awareness

Men with SCI, especially in the early years post-injury, should be considered a high fracture risk group, necessitating early intervention and management.

Targeted Pharmacological Interventions

Preventive pharmacological agents for individuals with SCI should primarily target lower limb fracture risk due to regional differences in bone loss severity.

Importance of Body Composition

Maintaining adequate skeletal muscle mass and reducing adiposity can potentially improve bone density in the SCI population.

Study Limitations

1
Changes in DXA equipment during the study period could have introduced measurement errors.
2
The study population only included men with SCI, limiting generalizability to women.
3
Data on medication intake, including anti-osteoporotic drugs, were not available.

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