The Pathophysiology, Identification and Management of Fracture Risk, Sublesional Osteoporosis and Fracture among Adults with Spinal Cord Injury

This review synthesizes established best practices and guideline recommendations from international consensus documents to address lower extremity fractures in adults with chronic spinal cord injury (SCI). It covers the pathophysiology of bone mineral density decline after SCI, screening and diagnosis of osteoporosis, and treatments including dietary supplements, rehabilitation, and drug therapy. The review also emphasizes the importance of timely orthopedic consultation for fracture diagnosis and interprofessional care to prevent health complications and facilitate rehabilitation to regain pre-fracture functional abilities.

• 1
  Acute SCI leads to rapid declines in bone mass in the hip, distal femur, and proximal tibia, resulting in sublesional osteoporosis and increased fracture risk.
• 2
  Vitamin D insufficiency is highly prevalent among individuals with SCI and is associated with low serum testosterone levels, impaired immune function, and reduced physical activity.
• 3
  Rehabilitation therapies like NMES and FES are recommended for treating low bone mass or osteoporosis, but interventions need to be continuous to maintain effects.