The Pathophysiology, Identification and Management of Fracture Risk, Sublesional Osteoporosis and Fracture among Adults with Spinal Cord Injury

Abstract

Background: The prevention of lower extremity fractures and fracture-related morbidity and mortality is a critical component of health services for adults living with chronic spinal cord injury (SCI). Methods: Established best practices and guideline recommendations are articulated in recent international consensus documents from the International Society of Clinical Densitometry, the Paralyzed Veterans of America Consortium for Spinal Cord Medicine and the Orthopedic Trauma Association. Results: This review is a synthesis of the aforementioned consensus documents, which highlight the pathophysiology of lower extremity bone mineral density (BMD) decline after acute SCI. The role and actions treating clinicians should take to screen, diagnose and initiate the appropriate treatment of established low bone mass/osteoporosis of the hip, distal femur or proximal tibia regions associated with moderate or high fracture risk or diagnose and manage a lower extremity fracture among adults with chronic SCI are articulated. Guidance regarding the prescription of dietary calcium, vitamin D supplements, rehabilitation interventions (passive standing, functional electrical stimulation (FES) or neuromuscular electrical stimulation (NMES)) to modify bone mass and/or anti-resorptive drug therapy (Alendronate, Denosumab, or Zoledronic Acid) is provided. In the event of lower extremity fracture, the need for timely orthopedic consultation for fracture diagnosis and interprofessional care following definitive fracture management to prevent health complications (venous thromboembolism, pressure injury, and autonomic dysreflexia) and rehabilitation interventions to return the individual to his/her pre-fracture functional abilities is emphasized. Conclusions: Interprofessional care teams should use recent consensus publications to drive sustained practice change to mitigate fracture incidence and fracture-related morbidity and mortality among adults with chronic SCI.

Best Bisphosphonate Threshold for 10-Year Vertebral and Non-vertebral Fracture Mitigation

“…Ageing and menopause-related bone loss cause primary osteoporosis in women. Medical conditions or medications can cause secondary osteoporosis [ 7 - 9 ].…”

“…Ageing and menopause-related bone loss cause primary osteoporosis in women. Medical conditions or medications can cause secondary osteoporosis[7][8][9].A detailed clinical history, including drug history and exam, is needed for diagnosis. BMD, age, and previous fractures predict perimenopausal fractures.…”

Rehabilitation: Neurogenic Bone Loss after Spinal Cord Injury

“…Due to lack of physical activity and increased immobilization after one suffers from severe SCI, muscle and bone tissue severely decrease [ 11 , 12 ]. Osteoporosis is a common issue experienced after SCI and is defined as a skeletal disorder in which bone strength is compromised, leaving a person with a greater risk of fracture [ 13 , 14 ]. Individuals with osteoporosis experience large levels of osteopenia and are prone to fractures, which severely decrease quality of life and require substantial medical resources.…”