+ Site Statistics
+ Search Articles
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ PDF Full Text
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Translate
+ Recently Requested

Long-term changes in bone metabolism, bone mineral density, quantitative ultrasound parameters, and fracture incidence after spinal cord injury: a cross-sectional observational study in 100 paraplegic men

Long-term changes in bone metabolism, bone mineral density, quantitative ultrasound parameters, and fracture incidence after spinal cord injury: a cross-sectional observational study in 100 paraplegic men

Osteoporosis International 15(3): 180-189

To study the time course of demineralization and fracture incidence after spinal cord injury (SCI), 100 paraplegic men with complete motor loss were investigated in a cross-sectional study 3 months to 30 years after their traumatic SCI. Fracture history was assessed and verified using patients' files and X-rays. BMD of the lumbar spine (LS), femoral neck (FN), distal forearm (ultradistal part = UDR, 1/3 distal part = 1/3R), distal tibial diaphysis (TDIA), and distal tibial epiphysis (TEPI) was measured using DXA. Stiffness of the calcaneus (QUI.CALC), speed of sound of the tibia (SOS.TIB), and amplitude-dependent SOS across the proximal phalanges (adSOS.PHAL) were measured using QUS. Z-Scores of BMD and quantitative ultrasound (QUS) were plotted against time-since-injury and compared among four groups of paraplegics stratified according to time-since-injury (<1 year, stratum I; 1-9 years, stratum II; 10-19 years, stratum III; 20-29 years, stratum IV). Biochemical markers of bone turnover (deoxypyridinoline/creatinine (D-pyr/Cr), osteocalcin, alkaline phosphatase) and the main parameters of calcium phosphate metabolism were measured. Fifteen out of 98 paraplegics had sustained a total of 39 fragility fractures within 1,010 years of observation. All recorded fractures were fractures of the lower limbs, mean time to first fracture being 8.9 +/- 1.4 years. Fracture incidence increased with time-after-SCI, from 1% in the first 12 months to 4.6%/year in paraplegics since >20 years ( p<.01). The overall fracture incidence was 2.2%/year. Compared with nonfractured paraplegics, those with a fracture history had been injured for a longer time ( p<.01). Furthermore, they had lower Z-scores at FN, TEPI, and TDIA ( p<.01 to <.0001), the largest difference being observed at TDIA, compared with the nonfractured. At the lower limbs, BMD decreased with time at all sites ( r=.49 to.78, all p<.0001). At FN and TEPI, bone loss followed a log curve which leveled off between 1 to 3 years after injury. In contrast, Z-scores of TDIA continuously decreased even beyond 10 years after injury. LS BMD Z-score increased with time-since-SCI ( p<.05). Similarly to DXA, QUS allowed differentiation of early and rapid trabecular bone loss (QUI.CALC) vs slow and continuous cortical bone loss (SOS.TIB). Biochemical markers reflected a disproportion between highly elevated bone resorption and almost normal bone formation early after injury. Turnover declined following a log curve with time-after-SCI, however, D-pyr/Cr remained elevated in 30% of paraplegics injured >10 years. In paraplegic men early (trabecular) and persistent (cortical) bone loss occurs at the lower limbs and leads to an increasing fracture incidence with time-after-SCI.

(PDF emailed within 0-6 h: $19.90)

Accession: 049490009

Download citation: RISBibTeXText

PMID: 14722626

DOI: 10.1007/s00198-003-1529-6

Related references

Influences of nutrition and adiposity on bone mineral density in individuals with chronic spinal cord injury: A cross-sectional, observational study. Bone Reports 2: 26-31, 2015

Bone Metabolism Markers and Bone Mineral Density in Patients on Long-Term Acenocoumarol Treatment: A Cross-Sectional Study. Journal of Clinical Medicine 7(10), 2018

Patient-specific bone mineral density distribution in the tibia of individuals with chronic spinal cord injury, derived from multi-slice peripheral Quantitative Computed Tomography (pQCT) - A cross-sectional study. Bone 97: 29-37, 2016

Long-term consequences of fracture of the lower leg: Cross-sectional study and long-term longitudinal follow-up of bone mineral density in the hip after fracture of lower leg. Bone (New York) 24(2): 131-134, 1999

Long-term changes in the tibia and radius bone mineral density following spinal cord injury. Spinal Cord 43(2): 96-101, 2004

Bone mineral density differences between paraplegic and quadriplegic patients: a cross-sectional study. Spinal Cord 37(5): 358-361, 1999

Bone mineral density, quantitative ultrasound parameters and bone metabolism in postmenopausal women with depression. Internal and Emergency Medicine 8(6): 485-491, 2014

Bone mineral density and indexes of bone metabolism in spinal cord injury. American Journal of Physical Medicine and Rehabilitation 77(1): 28-35, 1998

Ultrasound bone densitometry and dual energy X-ray absorptiometry in patients with spinal cord injury: a cross-sectional study. Spinal Cord 34(12): 736-741, 1996

Bone mineral density and quantitative ultrasound parameters in patients with Klinefelter's syndrome after long-term testosterone substitution. Osteoporosis International 12(1): 55-62, 2001

Serum leptin, bone mineral density and the healing of long bone fractures in men with spinal cord injury. Bosnian Journal of Basic Medical Sciences 15(4): 69-74, 2016

Cortical and trabecular bone mineral density in transsexuals after long-term cross-sex hormonal treatment: a cross-sectional study. Osteoporosis International 16(7): 791-798, 2004

Bone density loss after spinal cord injury: elite paraplegic basketball players vs. paraplegic sedentary persons. American Journal of Physical Medicine and Rehabilitation 83(4): 279-283, 2004

Bone mineral density in long-term Chinese heart transplant recipients: a cross-sectional study. Transplantation Proceedings 38(7): 2141-2144, 2006

Bone fractures and lumbar mineral density after renal transplantation. A long-term cross-sectional study. Clinical Transplantation 30(2): 131-137, 2016