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Exploring the determinants of fracture risk among individuals with spinal cord injury

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In this cross-sectional study, we found that areal bone mineral density (aBMD) at the knee and specific tibia bone geometry variables are associated with fragility fractures in men and women with chronic spinal cord injury (SCI).


Low aBMD of the hip and knee regions have been associated with fractures among individuals with chronic motor complete SCI; however, it is unclear whether these variables can be used to identify those at risk of fracture. In this cross-sectional study, we examined whether BMD and geometry measures are associated with lower extremity fragility fractures in individuals with chronic SCI.


Adults with chronic [duration of injury ≥ 2 years] traumatic SCI (C1-L1 American Spinal Cord Injury Association Impairment Scale A-D) reported post injury lower extremity fragility fractures. Dual-energy X-ray absorptiometry (DXA) was used to measure aBMD of the hip, distal femur, and proximal tibia regions, while bone geometry at the tibia was assessed using peripheral quantitative computed tomography (pQCT). Logistic regression and univariate analyses were used to identify whether clinical characteristics or bone geometry variables were associated with fractures.


Seventy individuals with SCI [mean age (standard deviation [SD]), 48.8 (11.5); 20 females] reported 19 fragility fractures. Individuals without fractures had significantly greater aBMD of the hip and knee regions and indices of bone geometry. Every SD decrease in aBMD of the distal femur and proximal tibia, trabecular volumetric bone mineral density, and polar moment of inertia was associated with fracture prevalence after adjusting for motor complete injury (odds ratio ranged from 3.2 to 6.1).


Low knee aBMD and suboptimal bone geometry are significantly associated with fractures. Prospective studies are necessary to confirm the bone parameters reported to predict fracture risk in individuals with low bone mass and chronic SCI.

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The authors acknowledge the support from the Ontario Neurotrauma Foundation (grant #2009-SC-MA-684), the Canadian Institutes of Health Research (grant #86521), the Spinal Cord Injury Solutions Network (RHI; grant #2010-43), and the Toronto Rehabilitation Institute who receives funding under the Provincial Rehabilitation Research Program from the Ministry of Health and Long-Term Care. The views expressed do not necessarily reflect those of the ministry.

Conflicts of interest

A. Papiaoannou, JD. Adachi - Consultant/Speaker: Amgen, Eli Lillly, GSK, Merk, Novartis, Warner-Chilcott; Clinic Trials: Eli Lilly, Merck, Novartism, Pfizer.

M. Popovic - Share holder in MyndTec.

L. Giangregorio - Research Support: Merck.

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Correspondence to L. M. Giangregorio.

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Lala, D., Craven, B.C., Thabane, L. et al. Exploring the determinants of fracture risk among individuals with spinal cord injury. Osteoporos Int 25, 177–185 (2014).

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