L Abderhalden1,2, F M Weaver1,3, M Bethel4,5, H Demirtas2, S Burns6,7, J Svircev6,7, H Hoenig8, K Lyles9,10, S Miskevics3, L D Carbone11,12. 1. Center of Innovation for Complex Chronic Healthcare, Edward J. Hines, Jr. VA Hospital, 5000 S. 5th Ave, P.O. Box 1033, Hines, IL, USA. 2. Department of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, IL, USA. 3. Public Health Sciences, Stritch School of Medicine, Loyola University, Maywood, IL, USA. 4. Charlie Norwood Veterans Affairs Medical Center, 950 15th St, 6D-155, Augusta, GA, 30912, USA. 5. Department of Medicine, Medical College of Georgia, Augusta University, Augusta, GA, USA. 6. VA Puget Sound Health Care System-Seattle Division, 1660 S. Columbian Way, Seattle, WA, USA. 7. Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA. 8. Durham VA Medical Center, 508 Fulton St, Durham, NC, USA. 9. Duke University and VA Medical Centers, Durham, NC, USA. 10. The Carolinas Center for Medical Excellence, Cary, NC, USA. 11. Charlie Norwood Veterans Affairs Medical Center, 950 15th St, 6D-155, Augusta, GA, 30912, USA. lcarbone@gru.edu. 12. Department of Medicine, Medical College of Georgia, Augusta University, Augusta, GA, USA. lcarbone@gru.edu.
Abstract
Low T-scores at the hip predict incident fractures in persons with a SCI. INTRODUCTION: Persons with a spinal cord injury (SCI) have substantial morbidity and mortality following osteoporotic fractures. The objective of this study was to determine whether dual-energy X-ray absorptiometry (DXA) measurements predict osteoporotic fractures in this population. METHODS: A retrospective historical analysis that includes patients (n = 552) with a SCI of at least 2 years duration who had a DXA performed and were in the VA Spinal Cord Disorders Registry from fiscal year (FY) 2002-2012 was performed. RESULTS: The majority of persons (n = 455, 82%) had a diagnosis of osteoporosis or osteopenia, with almost half having osteoporosis. BMD and T-scores at the lumbar spine were not significantly associated with osteoporotic fractures (p > 0.48) for both. In multivariable analyses, osteopenia (OR = 4.75 95% CI 1.23-17.64) or osteoporosis (OR = 4.31, 95% CI 1.15-16.23) compared with normal BMD was significantly associated with fractures and higher T-scores at the hip were inversely associated with fractures (OR 0.73 (95% CI 0.57-0.92)). There was no significant association of T-scores or World Health Organization (WHO) classification with incident fractures in those with complete SCI (p > 0.15 for both). CONCLUSION: The majority (over 80%) of individuals with a SCI have osteopenia or osteoporosis. DXA-derived measurements at the hip, but not the lumbar spine, predict fracture risk in persons with a SCI. WHO-derived bone density categories may be useful in classifying fracture risk in persons with a SCI.
Low T-scores at the hip predict incident fractures in persons with a SCI. INTRODUCTION:Persons with a spinal cord injury (SCI) have substantial morbidity and mortality following osteoporotic fractures. The objective of this study was to determine whether dual-energy X-ray absorptiometry (DXA) measurements predict osteoporotic fractures in this population. METHODS: A retrospective historical analysis that includes patients (n = 552) with a SCI of at least 2 years duration who had a DXA performed and were in the VA Spinal Cord Disorders Registry from fiscal year (FY) 2002-2012 was performed. RESULTS: The majority of persons (n = 455, 82%) had a diagnosis of osteoporosis or osteopenia, with almost half having osteoporosis. BMD and T-scores at the lumbar spine were not significantly associated with osteoporotic fractures (p > 0.48) for both. In multivariable analyses, osteopenia (OR = 4.75 95% CI 1.23-17.64) or osteoporosis (OR = 4.31, 95% CI 1.15-16.23) compared with normal BMD was significantly associated with fractures and higher T-scores at the hip were inversely associated with fractures (OR 0.73 (95% CI 0.57-0.92)). There was no significant association of T-scores or World Health Organization (WHO) classification with incident fractures in those with complete SCI (p > 0.15 for both). CONCLUSION: The majority (over 80%) of individuals with a SCI have osteopenia or osteoporosis. DXA-derived measurements at the hip, but not the lumbar spine, predict fracture risk in persons with a SCI. WHO-derived bone density categories may be useful in classifying fracture risk in persons with a SCI.
Authors: L Gifre; J Vidal; J L Carrasco; A Muxi; E Portell; A Monegal; N Guañabens; P Peris Journal: Osteoporos Int Date: 2015-09-30 Impact factor: 4.507
Authors: Somnath Sarkar; Bruce H Mitlak; Mayme Wong; John L Stock; Dennis M Black; Kristine D Harper Journal: J Bone Miner Res Date: 2002-01 Impact factor: 6.741
Authors: Leslie R Morse; Andrew Geller; Ricardo A Battaglino; Kelly L Stolzmann; Kirby Matthess; Antonio A Lazzari; Eric Garshick Journal: Am J Phys Med Rehabil Date: 2009-01 Impact factor: 2.159
Authors: L Abderhalden; F M Weaver; M Bethel; H Demirtas; S Burns; J Svircev; H Hoenig; K Lyles; S Miskevics; L D Carbone Journal: Osteoporos Int Date: 2017-05-15 Impact factor: 4.507
Authors: Frances M Weaver; Brian Le; Cara Ray; Scott Miskevics; Beverly Gonzalez; Laura D Carbone Journal: J Spinal Cord Med Date: 2019-03-19 Impact factor: 1.985
Authors: Nour Zleik; Frances Weaver; Robert L Harmon; Brian Le; Reshmitha Radhakrishnan; Wanda D Jirau-Rosaly; B Catharine Craven; Mattie Raiford; Jennifer N Hill; Bella Etingen; Marylou Guihan; Michael H Heggeness; Cara Ray; Laura Carbone Journal: J Spinal Cord Med Date: 2018-05-10 Impact factor: 1.985