Fractures after myelopathy: the risk quantified.

Fractures of the lower extremities have been recognized as a complication of paralysis with myelopathy due to spinal cord injury and impairment (SCI), but the risk has not been quantified and the effect of age, a correlate of predisposing osteoporosis, has not been documented. A long term follow-up review of patients with SCI was conducted to answer these questions. One hundred twenty male SCI patients (91 percent traumatic) were reviewed; the duration of paralysis at follow-up was 21.1 +/- 12.1 years. Forty patients (33 percent) had sustained 76 fracture events resulting in 103 fractures (82 percent in the long bones of the lower extremities). The incidence of fracture events was directly related to age (14.5, 31.1 and 45.7 events per 1000 patient years for age intervals of 20 to 39, 40 to 59 and 60 to 79 years, respectively). Incidence rates for femoral (including hip) fracture in SCI patients were greater than those for the general population of men by factors of 104 and 24 at ages 50 and 70, respectively. In conclusion, the risk of fracture of lower extremity long bones in men is markedly increased by myelopathy and is raised further with aging.