Article

People with spinal cord injury (SCI) experience bone loss and have an
elevated rate of fracture in the paralysed limbs. The literature suggests an
exponential time course of bone loss after SCI, but true rates may vary between
patients. We propose systematic evaluation of bone status in the early stages of
SCI to identify fast bone losers. METHOD: A case series of six patients with
complete SCI were scanned using peripheral quantitative computed tomography
within 5 weeks and at 4, 8 and 12 months post-injury. Bone mineral density (BMD)
and bone mineral content (BMC) were measured at fracture-prone sites in the tibia
and femur. Patient-specific-predictions (PSP) of expected rates of bone loss were
produced by individualising published model equations according to each patient's
measured values at baseline. Wilcoxon Signed-Rank tests were used to identify
changes between time-points; chi-squared tests for differences between measured
and PSP values. RESULTS: In the lower limbs, mean values decreased significantly
between baseline and 8 months post-injury, by 19-31% for trabecular BMD, 21-32%
for total BMD, and 9-29% for BMC. Most subjects showed no significant differences
between PSP and measured values, but individuals with significantly faster rates
of bone loss than predicted should be investigated further. CONCLUSIONS: There
was considerable intersubject variability in rates of bone loss after SCI.
Patients showing the fastest bone loss could benefit from continued follow-up and
possibly treatment.

Langue : ANGLAIS