The Journal of Spinal Cord Medicine, 2019 · DOI: 10.1080/10790268.2018.1469808 · Published: January 1, 2019
This review examines strategies to assess fracture risk, prevent and treat osteoporosis, and manage osteoporotic fractures in individuals with spinal cord injury or disorder (SCI/D). It identifies gaps in existing literature and makes recommendations for future research. The review included 226 articles. It found that risk of osteoporotic fractures in SCI is predicted by a combination of DXA-defined low BMD plus clinical and demographic characteristics. Screening for secondary causes of osteoporosis should be considered. Current antiresorptive therapies have limited efficacy. Surgical treatment of fractures has increased and outcomes are good and comparable to conservative treatment in most cases. Delayed healing was a common adverse event following fracture.
Combining DXA-defined low BMD with clinical and demographic characteristics can enhance the identification of individuals with SCI/D at high risk of osteoporotic fractures.
Implementing screening protocols for secondary causes of osteoporosis, such as hyperparathyroidism, hyperthyroidism, vitamin D insufficiency, and hypogonadism, can optimize patient care.
Considering surgical intervention for fractures, as outcomes are comparable to conservative treatment in many cases, while also addressing the risk of delayed healing.