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Bone Loss and the Current Diagnosis of Osteoporosis and Risk of Fragility Fracture in Persons with Spinal Cord Injury

  • Spinal Cord Injury Rehabilitation (J Donovan, Section Editor)
  • Published:
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Abstract

Purpose of Review

The topics to be discussed in this article include bone loss in the regions of the lower extremity that are most prone to fracture, the risk factors for fracture, the diagnosis of osteoporosis in persons with spinal cord (SCI), the determination of the fracture threshold at the knee, and a brief discussion of future directions.

Recent Findings

Extensive cross-sectional studies, but a paucity of longitudinal studies, that describe the precipitous bone loss occurs during the acute phase of SCI that likely continues, albeit more gradually, over the lifetime. The distal femur (DF) and proximal tibia (PT) are the regions that are at the highest risk for fracture. The most predictive risk factor for fracture in persons with SCI is low areal bone mineral density (aBMD). Dual energy x-ray absorptiometry (DXA) is the most practical and accurate imaging method to assess DF and PT aBMD but, historically, insufficient standardization of this method has limited its clinical application.

Summary

The DF and PT regions should be assessed in persons with SCI using recently available DXA acquisition methodology and, once available, applying an appropriate reference dataset at the knee region collected from young, healthy able-bodied individuals.

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Funding

This article is financially supported by the Veterans Affairs Rehabilitation Research and Development Service (#B2020-C) and the James J. Peters VA Medical Center.

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Authors and Affiliations

  1. Department of Veterans Affairs Rehabilitation Research & Development Service National Center for the Medical Consequences of Spinal Cord Injury, James J. Peters Veterans Affairs Medical Center, 130 West Kingsbridge Road, Bronx, NY, 10468, USA

    Christopher M. Cirnigliaro & William A. Bauman

  2. Kessler Institute for Rehabilitation, West Orange, NJ, USA

    Steven C. Kirshblum

  3. Rutgers New Jersey Medical School, Newark, NJ, USA

    Steven C. Kirshblum

  4. Departments of Medicine and Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    William A. Bauman

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  1. Christopher M. Cirnigliaro
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Correspondence to Christopher M. Cirnigliaro.

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Christopher M. Cirnigliaro, MS, Steven C. Kirshblum, MD, and William A. Bauman, MD have no conflict of interest or financial disclosure with regard to the information presented.

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This article is part of the Topical Collection on Spinal Cord Injury Rehabilitation

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Cirnigliaro, C.M., Kirshblum, S.C. & Bauman, W.A. Bone Loss and the Current Diagnosis of Osteoporosis and Risk of Fragility Fracture in Persons with Spinal Cord Injury. Curr Phys Med Rehabil Rep 8, 127–140 (2020). https://doi.org/10.1007/s40141-020-00268-2

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