Osteoporosis in the lower extremities in chronic spinal cord injury.

STUDY DESIGN Cross-sectional study. OBJECTIVES To investigate the effect of chronic motor complete spinal cord injury (SCI) and sex on bone densitometry parameters of the hip, femoral neck, tibial epiphysis, and diaphysis and on long bone fractures. SETTING SCI rehabilitation center. METHODS Women and men with long-term (≥7 years) motor complete SCI were compared with able-bodied women and men. Dual-energy X-ray absorptiometry was used to assess bone densitometry parameters at the hip and femoral neck, whereas peripheral quantitative computed tomography was used for the tibial epiphysis and diaphysis. RESULTS The data of 18 women and 25 men with SCI with a mean age of 54.7 ± 12.4 and 53.5 ± 8.6 years, respectively, were analyzed. As reference groups, 74 able-bodied women and 46 men with a mean age of 51.0 ± 13.1 and 50.9 ± 11.2 years were evaluated. Most bone densitometry values were significantly (p ≤ 0.033) lower in the SCI compared with the reference groups, including total bone mineral density at the distal tibial epiphysis (-58.0% in SCI women and -53.6% in SCI men). Fracture rates per 100 patient-years were 3.17 and 2.66 in women and men with SCI compared with 0.85 and 0.21 in able-bodied women and men, respectively. CONCLUSIONS Compared with able-bodied women and men, individuals with chronic motor complete SCI showed considerably lower bone densitometry values and a higher historical fracture rate. These findings support the need for preventative and therapeutic strategies against bone loss in individuals with SCI

Post-traumatic changes in energy expenditure and body composition in patients with acute spinal cord injury

Study design: Prospective cohort study. Objective: To investigate the changes in resting energy expenditure and body composition over time in a cohort of patients with spinal cord injury during acute treatment, rehabilitation, and 2 years after the end of rehabilitation. Methods: Adult patients admitted for acute treatment and rehabilitation after traumatic spinal cord injury were recruited. Measurements of resting energy expenditure and body composition were scheduled at 2, 6, 10 and 14 weeks after spinal cord injury, at the end of rehabilitation, and 2 years later. Results: Patients’ mean age was 38.8 years (standard deviation 14.0). Resting energy expenditure began to decrease up to the 10-week measurement (p = 0.02) and further decreased after the 130-week measurement (p < 0.001). Body weight was already decreased after the 6-week measurement (p < 0.01) and increased after the end of rehabilitation (p = 0.009). Percentage body fat mass showed similar changes. Conclusion: After an initial decrease in resting energy expenditure, body weight and percentage of body fat, these values levelled off during the rehabilitation period. After the end of the rehabilitation period, body weight and body fat mass increased again to the baseline levels, whereas resting energy expenditure decreased further. These results suggest that rehabilitation programmes should focus on adapting to these foreseeable changes