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Exploring changes in bone mass in individuals with a chronic spinal cord injury

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Abstract

Summary

People experience rapid bone loss shortly after a spinal cord injury (SCI), but the long-term bone changes are yet to be confirmed. This study showed that trabecular bone may have reached a steady state, whereas cortical bone continued to decline in people with a chronic SCI (mean time post injury: 15.5 ± 10 years).

Introduction

(1) To explore changes in bone [primary measure: trabecular volumetric bone mineral density (vBMD); secondary measures: cortical vBMD, cortical thickness, cortical cross-sectional area (CSA), and polar moment of inertia] over 2 years in individuals with a chronic spinal cord injury (SCI). (2) To explore whether muscle density changes were potential correlates of the observed bone changes.

Methods

This study is a secondary data analysis of a prospective, observational study involving 70 people with a chronic SCI (≥ 2 years post injury). The study included 4 strata of participants with diverse impairments: (1) Paraplegia (T1-T12) motor complete American Spinal Injury Association Impairment Scale (AIS) A/B (n = 23), (2) Paraplegia motor incomplete AIS C/D (n = 11), (3) Tetraplegia (C2-C8) AIS A/B (n = 22), and (4) Tetraplegia AIS C/D (n = 14). Peripheral quantitative computed tomography scans were taken at the 4% (distal tibia), 38% (diaphyseal tibia), and 66% (muscle cross-sectional area) tibia sites by measuring from the distal to proximal tibia starting at the inferior border of the medial malleolus. The tibia sites were assessed annually over a span of 2 years. Comparisons were made using a paired-samples t test and simple linear regression was used to adjust for sex, time post injury, and bisphosphonate use.

Results

We observed no changes in trabecular vBMD at the 4% tibia site, but there was a statistically significant decline in cortical vBMD, cortical thickness, and CSA at the 38% tibia site. Changes in muscle density were not associated with the decreases observed in cortical bone.

Conclusion

Our findings suggest that individuals with chronic SCI (mean duration of injury: 15.5 ± 10 years) may have reached a plateau in bone loss with respect to trabecular bone, but cortical bone loss can continue well into the chronic stages.

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Funding

This study received funding from the Ontario Neurotrauma Foundation (Grant #2009-SC-MA-684), the Canadian Institutes of Health Research (Grant #86521), and the Spinal Cord Injury Solutions Network (Grant #2010-43).

Author information

Authors and Affiliations

  1. Deparment of Kinesiology, University of Waterloo, 200 University Ave W, Waterloo, ON, N2L 3G1, Canada

    R. El-Kotob & L.M. Giangregorio

  2. KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, M4G 3V9, Canada

    R. El-Kotob & B.C. Craven

  3. Department of Medicine, University of Toronto, Toronto, ON, M5S 1A8, Canada

    B.C. Craven

  4. Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, L8S 4L8, Canada

    L. Thabane & A. Papaioannou

  5. Department of Medicine, McMaster University, Hamilton, ON, L8S 4L8, Canada

    A. Papaioannou & J.D. Adachi

  6. Schlegel-University of Waterloo Research Institute for Aging, Waterloo, ON, N2J 0E2, Canada

    L.M. Giangregorio

Authors
  1. R. El-Kotob
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  2. B.C. Craven
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  3. L. Thabane
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  4. A. Papaioannou
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  5. J.D. Adachi
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  6. L.M. Giangregorio
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Corresponding author

Correspondence to R. El-Kotob.

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Conflicts of interest

Dr. Adachi reports grants and personal fees from Amgen, personal fees from Eli Lilly, outside the submitted work. Dr. Giangregorio reports grants from Canadian Institutes of Health Research, grants from Spinal Cord Injury Solutions Network, grants from Ontario Neurotrauma Foundation during the conduct of the study. The remaining authors declare that they have no conflicts of interest.

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El-Kotob, R., Craven, B., Thabane, L. et al. Exploring changes in bone mass in individuals with a chronic spinal cord injury. Osteoporos Int 32, 759–767 (2021). https://doi.org/10.1007/s00198-020-05705-5

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  • DOI: https://doi.org/10.1007/s00198-020-05705-5

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