Comparison of the prevalence of osteoporosis in people with spinal cord injury according to bone mineral density reference values for the diagnosis of osteoporosis: a retrospective, cross-sectional study

BMC Musculoskeletal Disorders, 2024 · DOI: https://doi.org/10.1186/s12891-024-07184-9 · Published: January 9, 2024

Spinal Cord Injury Musculoskeletal Medicine

Simple Explanation

Spinal cord injury (SCI) can lead to rapid bone loss and increase the risk of osteoporosis-related fractures. This study examines how different bone mineral density (BMD) reference values affect osteoporosis diagnosis in Korean adults with SCI. The study compared osteoporosis prevalence using T-scores from DXA manufacturers (regional) and the Third National Health and Nutrition Examination Survey (NHANES III) data (international) in individuals with SCI. The findings reveal differences in osteoporosis diagnosis and prevalence based on the BMD reference values used, highlighting the need for accurate diagnostic criteria for osteoporosis prevention in individuals with SCI.

Study Duration

2010-2020

Participants

855 Korean adults aged ≥ 50 years with SCI

Evidence Level

Not specified

Key Findings

1
The prevalence of osteoporosis was significantly higher using the NHANES III reference (TNHA) compared to the DXA manufacturer's reference (TDXA) in both males and females.
2
The lumbar spine was a major osteoporosis diagnosis site for TDXA, while the femoral neck was a major site for TNHA.
3
Risk factors for osteoporosis included older age, female sex, low BMI, and longer SCI period, regardless of the BMD reference value used.

Research Summary

This retrospective, cross-sectional study compared osteoporosis prevalence in Korean adults with SCI using different BMDRV: region-based from DXA manufacturers (TDXA) and international based on NHANES III data (TNHA). Results showed that osteoporosis prevalence was higher when using TNHA compared to TDXA. The diagnostic site also varied, with the lumbar spine being more prominent in TDXA and the femoral neck in TNHA. The study concludes that osteoporosis diagnosis in SCI patients differs based on the BMDRV used, emphasizing the need for further research to establish accurate diagnostic criteria specific to this population.

Practical Implications

Diagnostic Accuracy

Highlights the importance of selecting appropriate BMDRV for accurate osteoporosis diagnosis in SCI patients.

Targeted Prevention

Suggests that prevention strategies should consider the potential for different skeletal sites to be affected based on the diagnostic criteria used.

Further Research

Calls for more studies to establish BMDRV tailored for individuals with SCI to improve diagnostic accuracy and guide treatment strategies.

Study Limitations

1
Lunar BMD values were converted to Hologic BMD values for TDXA derivation, but the T-scores derived from each manufacturer were used in their original form without conversion.
2
Osteoporosis diagnosis in individuals with SCI should not be based on BMD alone; therefore, other factors, such as complications, lifestyle, range of activity, and drug use, should be considered depending on the SCI characteristics.
3
This study focused on the diagnostic standards for osteoporosis used in clinical practice, including the general public, and BMD measurements were performed at the lumbar spine, femoral neck, and total hip.

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