Measurement of Bone: Diagnosis of SCI-Induced Osteoporosis and Fracture Risk Prediction

Top Spinal Cord Inj Rehabil, 2015 · DOI: 10.1310/sci2104-267 · Published: January 1, 2015

Spinal Cord Injury Rehabilitation Musculoskeletal Medicine

Simple Explanation

Spinal cord injury (SCI) leads to rapid bone loss, causing severe osteoporosis and increasing fracture risk significantly. Preventing fractures in SCI patients is crucial due to the high rate of complications and diminished quality of life associated with them. Following SCI, bone undergoes biological and structural changes. This article reviews these changes and the methods used to assess bone health after SCI, including their strengths and limitations. While dual-energy x-ray absorptiometry (DXA) can detect bone changes after SCI, 3-dimensional methods like quantitative CT analysis are recommended for research due to their detailed assessment capabilities.

Study Duration

Not specified

Participants

31-100 paraplegic men

Evidence Level

Review

Key Findings

1
SCI results in a 5- to 23-fold increase in fracture risk compared to able-bodied individuals.
2
Bone loss after SCI occurs in two phases: a rapid acute phase within the first two years and a slower chronic phase that can persist for decades.
3
QCT measures show as much as 80% to 90% reductions in epiphyseal tibial BMC, with a corresponding 69% reduction in (finite element-predicted) fracture strength.

Research Summary

Spinal cord injury (SCI) leads to rapid bone loss, resulting in severe osteoporosis and a significantly increased risk of fractures, which are associated with high complication rates and reduced quality of life. The review discusses the biological and structural changes in bone post-SCI, highlighting the importance of preventing fractures and the lack of a standard treatment protocol for SCI-induced bone loss. While DXA is commonly used, the review suggests that 3D methods like quantitative CT analysis are more suitable for research applications due to their ability to detect subtle structural changes.

Practical Implications

Improved Diagnostic Accuracy

Adoption of 3D QCT analysis in research settings can lead to a more accurate understanding of bone changes post-SCI, improving the development of targeted interventions.

Personalized Fracture Risk Assessment

Integrating clinical risk factors with bone density measurements can help create personalized fracture risk assessment tools tailored for individuals with SCI.

Standardized Research Protocols

Establishing standardized protocols for QCT data acquisition and analysis will ensure consistent and reliable results across different research studies.

Study Limitations

1
The chronic phase of bone loss after SCI is poorly defined.
2
Current fracture risk assessment tools (like FRAX) have not been validated for the SCI population.
3
DXA measurements can be affected by patient positioning, heterotopic ossification, and instrumentation artifacts.

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