Osteoporosis in Veterans with Spinal Cord Injury: an Overview of Pathophysiology, Diagnosis, and Treatments

  • Michelle TrbovichEmail author
  • Denny Mack
  • Jan M. Bruder
Part of the following topical collections:
  1. Treating Bone loss in challenging situations


Immediately after spinal cord injury (SCI), approximately 75% of patients suffer rapid and severe loss of bone mineral density (BMD) below the lesion level (i.e., sublesional), leading to osteoporosis (OP) in ~ 60% 1-year post-injury. The distal femur (DF) and proximal tibia (PT) are most commonly involved, and 70% of SCI patients sustain a low impact fracture at some point in their lifetime, adding disability to an already physically challenged population. Unfortunately, OP treatments for post-menopausal women are not as effective for OP post-SCI. Mechanisms of new agents targeting the neurogenic etiology of bone resorption (i.e., denosumab and anti-sclerostin antibodies) may hold greater potential and are discussed. Furthermore, standardized DXA protocols with normative BMD values for the DF and PT sites have not been established, so diagnosing OP is problematic. This review will summarize the pathophysiology of sublesional OP after SCI, the unique challenges of diagnosing and managing OP in SCI patients and provide recommendations for future studies. Given the Veterans Health Administration (VA) is the largest health care system in the world for persons with SCI, it is well-equipped to add to gaps in the literature.


Spinal cord injury Neurogenic osteoporosis Dual energy x-ray absorptiometry Bone mineral density Fractures 



The authors acknowledge Dr. Leslie Morse and Christopher Cirnigliaro for their guidance and expertise in clinical screening protocols, Dr. Nancy Kellogg for her assistance with editing, and UT librarian Christine Gaspard for her expertise in literature search.

Compliance with Ethical Standards

This article does not contain any studies with human or animal subjects performed by the any of the authors.

Conflict of Interest

The authors declare that they have no conflicts of interest.

Informed Consent

Not applicable.


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Copyright information

© This is a U.S. government work and not under copyright protection in the U.S.; foreign copyright protection may apply 2019

Authors and Affiliations

  1. 1.South Texas Veteran’s Health Care System (STVHCS)San AntonioUSA
  2. 2.Department of Medicine, Division of EndocrinologyUT Health San Antonio, TXSan AntonioUSA

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