Cirnigliaro C M, Myslinski M J, La Fountaine M F, Kirshblum S C, Forrest G F, Bauman W A
Department of Veterans Affairs Rehabilitation Research & Development Service National Center for the Medical Consequences of Spinal Cord Injury, James J. Peters Veterans Affairs Medical Center, Bronx, NY, USA.
Department of Physical Therapy, School of Health Related Professions, Rutgers New Jersey Medical School, Newark, NJ, USA.
Osteoporos Int. 2017 Mar;28(3):747-765. doi: 10.1007/s00198-016-3798-x. Epub 2016 Dec 5.
Persons with spinal cord injury (SCI) undergo immediate unloading of the skeleton and, as a result, have severe bone loss below the level of lesion associated with increased risk of long-bone fractures. The pattern of bone loss in individuals with SCI differs from other forms of secondary osteoporosis because the skeleton above the level of lesion remains unaffected, while marked bone loss occurs in the regions of neurological impairment. Striking demineralization of the trabecular epiphyses of the distal femur (supracondylar) and proximal tibia occurs, with the knee region being highly vulnerable to fracture because many accidents occur while sitting in a wheelchair, making the knee region the first point of contact to any applied force. To quantify bone mineral density (BMD) at the knee, dual energy x-ray absorptiometry (DXA) and/or computed tomography (CT) bone densitometry are routinely employed in the clinical and research settings. A detailed review of imaging methods to acquire and quantify BMD at the distal femur and proximal tibia has not been performed to date but, if available, would serve as a reference for clinicians and researchers. This article will discuss the risk of fracture at the knee in persons with SCI, imaging methods to acquire and quantify BMD at the distal femur and proximal tibia, and treatment options available for prophylaxis against or reversal of osteoporosis in individuals with SCI.
脊髓损伤（SCI）患者的骨骼会立即失去负荷，因此，在损伤平面以下会出现严重的骨质流失，这与长骨骨折风险增加有关。SCI患者的骨质流失模式不同于其他形式的继发性骨质疏松症，因为损伤平面以上的骨骼不受影响，而神经损伤区域会出现明显的骨质流失。股骨远端（髁上）和胫骨近端的小梁骨骺会出现明显的脱矿，膝关节区域极易发生骨折，因为坐在轮椅上时会发生许多意外，使得膝关节区域成为任何外力作用的第一接触点。为了量化膝关节处的骨密度（BMD），临床和研究环境中通常采用双能X线吸收法（DXA）和/或计算机断层扫描（CT）骨密度测定法。迄今为止，尚未对获取和量化股骨远端和胫骨近端BMD的成像方法进行详细综述，但如果有相关综述，将为临床医生和研究人员提供参考。本文将讨论SCI患者膝关节骨折的风险、获取和量化股骨远端和胫骨近端BMD的成像方法，以及针对SCI患者预防或逆转骨质疏松症的可用治疗方案。
