Reduction in Proximal Femoral Strength in Patients With Acute Spinal Cord Injury
Article first published online: 20 AUG 2014
© 2014 American Society for Bone and Mineral Research
Journal of Bone and Mineral Research
Volume 29, Issue 9, pages 2074–2079, September 2014
How to Cite
Edwards, W. B., Schnitzer, T. J. and Troy, K. L. (2014), Reduction in Proximal Femoral Strength in Patients With Acute Spinal Cord Injury. J Bone Miner Res, 29: 2074–2079. doi: 10.1002/jbmr.2227
- Issue published online: 20 AUG 2014
- Article first published online: 20 AUG 2014
- Accepted manuscript online: 27 MAR 2014 06:56AM EST
- Manuscript Accepted: 12 MAR 2014
- Manuscript Revised: 8 MAR 2014
- Manuscript Received: 12 FEB 2014
- Merck & Co, Inc.
- Zars Pharma, Inc.
- National Institutes of Health, Department of Defense, and Department of Education
- FINITE ELEMENT MODEL;
- DISUSE OSTEOPOROSIS;
- BONE FRACTURE
Bone loss after spinal cord injury (SCI) is associated with an increased risk of fracture resulting from minor trauma. Proximal femoral fractures account for approximately 10% to 20% of the fractures in this population and are among the most serious of injuries. Our purpose was to quantify changes to proximal femoral strength in patients with acute SCI. Thirteen subjects received dual-energy X-ray absorptiometry (DXA) and clinical computed tomography (CT) scans at serial time points during acute SCI separated by a mean of 3.5 months (range 2.6 to 4.8 months). Areal bone mineral density (aBMD) at the proximal femur was quantified from DXA, and proximal femoral strength was predicted using CT-based finite element (FE) modeling in a sideways fall configuration. During the acute period of SCI, femoral neck and total proximal femur aBMD decreased by 2.0 ± 1.1%/month (p < 0.001) and 2.2 ± 0.7%/month (p < 0.001), respectively. The observed reductions in aBMD were associated with a 6.9 ± 2.0%/month (p < 0.001) reduction in femoral strength. Thus, changes in femoral strength were some 3 times greater than the observed changes in aBMD (p < 0.001). It was interesting to note that in just 3.5 months of acute SCI, reductions in strength for some patients were on the order of that predicted for lifetime declines owing to aging. Therefore, it is important that therapeutic interventions are implemented soon after SCI in an effort to halt bone loss and decrease fracture risk. In addition, clinicians utilizing DXA to monitor bone health after SCI should be aware of the potential discrepancy between changes in aBMD and strength. © 2014 American Society for Bone and Mineral Research.