Sadowsky Cristina L, Mingioni Nina, Zinski Joseph
International Center for Spinal Cord Injury/Kennedy Krieger Institute, Baltimore, Maryland.
Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, Baltimore, Maryland.
Top Spinal Cord Inj Rehabil. 2020 Spring;26(2):128-133. doi: 10.46292/sci2602-128.
Individuals with spinal cord injury/disorder (SCI/D) are at high risk for developing secondary osteoporosis. Bone loss after neurologic injury is multifactorial and is dependent on the time from and extent of neurologic injury. Most bone loss occurs in the first year after complete motor paralysis, and fractures occur most commonly in the distal femur and proximal tibia (paraplegic fracture). The 2019 International Society for Clinical Densitometry Position Statement in SCI establishes that dual-energy X-ray absorptiometry (DXA) can be used to both diagnose osteoporosis and predict lower extremity fracture risk in individuals with SCI/D. Pharmacologic treatments used in primary osteoporosis have mixed results when used for SCI/D-related osteoporosis. Ambulation, standing, and electrical stimulation may be helpful at increasing bone mineral density (BMD) in individuals with SCI/D but do not necessarily correlate with fracture risk reduction. Clinicians caring for individuals with spinal cord-related paralysis must maintain a high index of suspicion for fragility fractures and consider referral for surgical evaluation and management.
脊髓损伤/疾病（SCI/D）患者发生继发性骨质疏松的风险很高。神经损伤后的骨质流失是多因素的，并且取决于神经损伤的时间和程度。大多数骨质流失发生在完全运动麻痹后的第一年，骨折最常发生在股骨远端和胫骨近端（截瘫性骨折）。2019年国际临床骨密度测量学会关于SCI的立场声明确定，双能X线吸收法（DXA）可用于诊断骨质疏松症，并预测SCI/D患者的下肢骨折风险。用于原发性骨质疏松症的药物治疗用于SCI/D相关骨质疏松症时效果不一。步行、站立和电刺激可能有助于提高SCI/D患者的骨矿物质密度（BMD），但不一定与降低骨折风险相关。照顾脊髓相关瘫痪患者的临床医生必须对脆性骨折保持高度怀疑，并考虑转诊进行手术评估和管理。
