Marked trabecular and cortical bone loss was observed at the proximal femur short-term after spinal cord injury (SCI). 3D-DXA provided measurement of vBMD evolution at both femoral compartments and cortical thinning, thereby suggesting that this technique could be useful for bone analysis in these patients.
SCI is associated with a marked increase in bone loss and risk of osteoporosis development short-term after injury. 3D-DXA is a new imaging analysis technique providing 3D analysis of the cortical and trabecular bone from DXA scans. The aim of this study was to assess the evolution of trabecular macrostructure and cortical bone using 3D-DXA in patients with recent SCI followed over 12 months.
Sixteen males with recent SCI (< 3 months since injury) and without antiosteoporotic treatment were included. Clinical assessment, bone mineral density (BMD) measurements by DXA, and 3D-DXA evaluation at proximal femur (analyzing the integral, trabecular and cortical volumetric BMD [vBMD] and cortical thickness) were performed at baseline and at 6 and 12 months of follow-up.
vBMD significantly decreased at integral, trabecular, and cortical compartments at 6 months (− 8.8, − 11.6, and − 2.4%), with a further decrease at 12 months, resulting in an overall decrease of − 16.6, − 21.9, and − 5.0%, respectively. Cortical thickness also decreased at 6 and 12 months (− 8.0 and − 11.4%), with the maximal decrease being observed during the first 6 months. The mean BMD losses by DXA at femoral neck and total femur were − 17.7 and − 21.1%, at 12 months, respectively.
Marked trabecular and cortical bone loss was observed at the proximal femur short-term after SCI. 3D-DXA measured vBMD evolution at both femoral compartments and cortical thinning, providing better knowledge of their differential contributory role to bone strength and probably of the effect of therapy in these patients.
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Spinal cord injury
Bone mineral density
Dual-energy X-ray absorptiometry
Quantitative computed tomography
Bone mineral content
Volumetric bone mineral density
Three-dimensional dual-energy X-ray absorptiometry
Body mass index
ASIA Impairment Scale
Areal bone mineral density
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The study was funded by the Fundació la Marató de TV3. LH received support by the Programa Estatal de Promoción del Talento y su Empleabilidad—Torres Quevedo, Ministerio de Economía y Competitividad (Reference: SPTQ1300X006124XV0).
Ethical approval was obtained from the Neurorehabilitation Guttmann Institute and from the Hospital Clinic of Barcelona Ethics Committees, and all participants provided written informed consent.
Conflicts of interest
Ludovic Humbert is a stakeholder of Galgo Medical. LG, AM, LR, JV, EP, AMo, NG, and PP state that they have no conflicts of interest.
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Gifre, L., Humbert, L., Muxi, A. et al. Analysis of the evolution of cortical and trabecular bone compartments in the proximal femur after spinal cord injury by 3D-DXA. Osteoporos Int 29, 201–209 (2018). https://doi.org/10.1007/s00198-017-4268-9
- Bone mineral density
- Spinal cord injury