Traumatic lower limb fractures following complete spinal cord injury.

Patients with complete spinal cord injury experience a rapid bone mineral density loss that places them at an increased risk of lower limb fracture following trivial injury. We aimed to establish if spinal cord injured patients treated at our unit have an increased incidence of lower limb fracture, and if so to identify a cohort of patients who may benefit from prophylactic treatment to preserve bone mineral density. We reviewed 158 patients treated between January 1994 and July 2002. There was a significantly increased incidence of lower limb fracture in patients with complete spinal cord injury (5 fractures in 4 patients), when compared to the cohort of patients with spinal injury who subsequently attained mobility (no fractures). Prophylactic bisphosphonates reduce disuse osteopenia and warrant prospective assessment in patients with complete spinal cord injury in whom they may confer a protective effect against lower limb fracture.