Ann Rehabil Med.  2021 Feb;45(1):1-6. 10.5535/arm.20169.

Correlation Between Duration From Injury and Bone Mineral Density in Individuals With Spinal Cord Injury

• Choi H
• Chang Sy
• Yoo J
• Lim SH
• Hong BY
• Kim JS

• KMID: 2513224
• DOI: http://doi.org/10.5535/arm.20169

Abstract

Objective
To investigate the correlation between bone mineral density (BMD) and duration of injury in individuals with spinal cord injury (SCI).
Methods
Patients with SCI who visited the outpatient department between January 2009 and January 2019 were enrolled. Patients’ most recent dual energy X-ray absorptiometry images were reviewed. According to the 2007 International Society for Clinical Densitometry guidelines, vertebrae with a local structural change were excluded when deriving spine BMD. If one or no vertebra is suitable for evaluation, spine BMD was judged as “improper for assessment”. Correlation analysis was performed between duration from injury and BMD Z-scores of the hip and spine.
Results
Among 83 individuals with SCI, the spines of 44 were judged as improper for assessment. The correlation analysis showed a significant negative relationship between the duration from injury and femur neck BMD (r=-0.40, p<0.01) and total proximal femur BMD (r=-0.39, p<0.01). However, no significant correlation was found between the duration from injury and spine BMD Z-score.
Conclusion
The duration of SCI correlated with hip BMD, but not with spine BMD. Further, more than half of the individuals with SCI could not undergo spinal assessment due to local structural changes. Therefore, spine BMD measurement is not an appropriate method for predicting future fracture risk in those with SCI.

Keyword

Spinal cord injuries, Bone density, Osteoporosis

Figure

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  Fig. 1. Spine bone mineral density (BMD) images of spinal cord injury (SCI) individuals. (A) The L3 vertebra of the case 1 shows local structural changes (arrow). In this case, spine BMD is calculated using the L1, L2, and L4 vertebrae. (B) Case 2 has L2-L5 laminectomy. (C) The L2, L3, and L4 vertebrae of case 3 show local structural changes (arrows).

Reference

1. Cirnigliaro CM, Myslinski MJ, Asselin P, Hobson JC, Specht A, La Fountaine MF, et al. Progressive sublesional bone loss extends into the second decade after spinal cord injury. J Clin Densitom. 2019; 22:185–94.

2. Jiang SD, Dai LY, Jiang LS. Osteoporosis after spinal cord injury. Osteoporos Int. 2006; 17:180–92.

3. Jiang SD, Jiang LS, Dai LY. Mechanisms of osteoporosis in spinal cord injury. Clin Endocrinol (Oxf). 2006; 65:555–65.

4. Biering-Sorensen F, Bohr H, Schaadt O. Bone mineral content of the lumbar spine and lower extremities years after spinal cord lesion. Paraplegia. 1988; 26:293–301.

5. Jaovisidha S, Sartoris DJ, Martin EM, De Maeseneer M, Szollar SM, Deftos LJ. Influence of spondylopathy on bone densitometry using dual energy X-ray absorptiometry. Calcif Tissue Int. 1997; 60:424–9.

6. Resnick D, Niwayama G. Degenerative disease of the spine. In : Resnick D, editor. Diagnosis of bone and joint disorders. 3rd ed. Philadelphia, PA: Saunders;1995. p. 1372–462.

7. Lewiecki EM, Gordon CM, Baim S, Leonard MB, Bishop NJ, Bianchi ML, et al. International Society for Clinical Densitometry 2007 Adult and Pediatric Official Positions. Bone. 2008; 43:1115–21.

8. Zleik N, Weaver F, Harmon RL, Le B, Radhakrishnan R, Jirau-Rosaly WD, et al. Prevention and management of osteoporosis and osteoporotic fractures in persons with a spinal cord injury or disorder: a systematic scoping review. J Spinal Cord Med. 2019; 42:735–59.

9. Abderhalden L, Weaver FM, Bethel M, Demirtas H, Burns S, Svircev J, et al. Dual-energy X-ray absorptiometry and fracture prediction in patients with spinal cord injuries and disorders. Osteoporos Int. 2017; 28:925–34.

10. Morse LR, Biering-Soerensen F, Carbone LD, Cervinka T, Cirnigliaro CM, Johnston TE, et al. Bone mineral density testing in spinal cord injury: 2019 ISCD Official Position. J Clin Densitom. 2019; 22:554–66.

11. Edwards WB, Schnitzer TJ. Bone imaging and fracture risk after spinal cord injury. Curr Osteoporos Rep. 2015; 13:310–7.

12. Cervinka T, Lynch CL, Giangregorio L, Adachi JD, Papaioannou A, Thabane L, et al. Agreement between fragility fracture risk assessment algorithms as applied to adults with chronic spinal cord injury. Spinal Cord. 2017; 55:985–93.

13. Eser P, Frotzler A, Zehnder Y, Denoth J. Fracture threshold in the femur and tibia of people with spinal cord injury as determined by peripheral quantitative computed tomography. Arch Phys Med Rehabil. 2005; 86:498–504.

14. Morse LR, Lazzari AA, Battaglino R, Stolzmann KL, Matthess KR, Gagnon DR, et al. Dual energy x-ray absorptiometry of the distal femur may be more reliable than the proximal tibia in spinal cord injury. Arch Phys Med Rehabil. 2009; 90:827–31.