Endocrinol Metab.  2023 Oct;38(5):578-587. 10.3803/EnM.2023.1795.

Characteristics Associated with Bone Loss after Spinal Cord Injury: Implications for Hip Region Vulnerability

• Han S
• Shin S
• Kim O
• Hong N

• KMID: 2546988
• DOI: http://doi.org/10.3803/EnM.2023.1795

Abstract

Background
In individuals with spinal cord injury (SCI), bone loss progresses rapidly to the area below the level of injury, leading to an increased risk of fracture. However, there are limited data regarding SCI-relevant characteristics for bone loss and the degree of bone loss in individuals with SCI compared with that in non-SCI community-dwelling adults.
Methods
Data from men with SCI who underwent dual-energy X-ray absorptiometry at the National Rehabilitation Center (2008 to 2020) between 12 and 36 months after injury were collected and analyzed. Community-dwelling men were matched 1:1 for age, height, and weight as the control group, using data from the Korea National Health and Nutrition Examination Survey (KNHANES, 2008 to 2011).
Results
A comparison of the SCI and the matched control group revealed significantly lower hip region T-scores in the SCI group, whereas the lumbar spine T-score did not differ between groups. Among the 113 men with SCI, the paraplegia group exhibited significantly higher Z-scores of the hip region than the tetraplegia group. Participants with motor-incomplete SCI showed relatively preserved Z-scores of the hip region compared to those of the lumbar region. Moreover, in participants with SCI, the percentage of skeletal muscle displayed a moderate positive correlation with femoral neck Z-scores.
Conclusion
Men with SCI exhibited significantly lower bone mineral density of the hip region than community-dwelling men. Paraplegia rather than tetraplegia, and motor incompleteness rather than motor completeness were protective factors in the hip region. Caution for loss of skeletal muscle mass or increased adiposity is also required.

Keyword

Spinal cord injuries; Osteoporosis; Bone density; Absorptiometry, photon; Femur neck

Figure

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  Fig. 1. Study flow chart. SCI, spinal cord injury; KNHANES, Korea National Health and Nutritional Examination Survey; DXA, dual-energy X-ray absorptiometry.

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  Fig. 2. Polynomial curve showing differences in (A) femoral neck, (B) total hip, and (C) lumbar spine T-scores between the two cohorts. NRC, National Rehabilitation Center; KNHANES, Korea National Health and Nutritional Examination Survey.

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  Fig. 3. Comparison of site-specific Z-scores (lumbar, femoral neck, and total hip) in the National Rehabilitation Center cohort between motor-complete and motor-incomplete injury groups.

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  Fig. 4. Partial correlation analysis showing moderate positive correlation between skeletal muscle percentage (%) and femoral neck Z-score in participants with available bioelectrical impedance analysis data in the National Rehabilitation Center cohort.

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