Department of Rehabilitation Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
Vejjarak Lampang Hospital, Ko Kha, Lampang, Thailand.
J Spinal Cord Med. 2023 May;46(3):458-465. doi: 10.1080/10790268.2022.2054763. Epub 2022 Apr 4.
To investigate the prevalence and influencing factors of spinal cord injury (SCI)-related osteoporosis and fragility fractures in Thai people with chronic spinal cord injury. A cross-sectional, observational study. Outpatient clinic, Department of Rehabilitation Medicine, Maharaj Nakorn Chiang Mai Hospital. Thais with chronic spinal cord injury (SCI) (duration of injury at least one year). Not applicable. Dual-energy X-ray absorptiometry (DXA) was performed to measure bone mineral density (BMD) at the hip. Analyses were performed to identify risk factors for SCI-related osteoporosis or fragility fracture development. Thai FRAX® score was calculated with and without BMD and compared for each participant. Among 64 Thais with chronic SCI, the prevalence of SCI-related osteoporosis was 43.8%. Female sex, non-ambulatory status, and at least 10 years duration of spinal cord injury increased the risk of having SCI-related osteoporosis. The prevalence of fragility fracture was 9.4%. Female sex, duration of SCI, and being diagnosed with SCI-related osteoporosis increased the risk of having a fragility fracture. Thai FRAX® score without BMD value underestimated the risk of prevalent fracture in 7.8% of participants. SCI-related osteoporosis and fragility fractures are common in Thais with chronic SCI. Our findings emphasize the importance of SCI-related osteoporosis and fragility fracture surveillance in people with chronic SCI regardless of their ethnicity. FRAX® without BMD calculations could underestimate the risk of fragility fracture in people with chronic SCI. Therefore, further studies are needed to develop an SCI-specific fracture-risk assessment tool using risk factors proposed in previous studies and in this study.
调查泰国慢性脊髓损伤患者中与脊髓损伤相关的骨质疏松症和脆性骨折的流行情况及其影响因素。方法：这是一项横断面、观察性研究。研究对象为泰国慢性脊髓损伤患者（损伤持续时间至少一年），在康复医学系门诊就诊。采用双能 X 线吸收法（DXA）测量髋部骨密度（BMD）。分析确定与脊髓损伤相关的骨质疏松症或脆性骨折发生的危险因素。计算并比较每位患者的泰国 FRAX®评分（基于和不基于 BMD 值）。结果：64 例泰国慢性脊髓损伤患者中，与脊髓损伤相关的骨质疏松症的患病率为 43.8%。女性、非步行状态和脊髓损伤持续时间至少 10 年，增加了发生与脊髓损伤相关的骨质疏松症的风险。脆性骨折的患病率为 9.4%。女性、脊髓损伤持续时间和诊断为与脊髓损伤相关的骨质疏松症，增加了发生脆性骨折的风险。不考虑 BMD 值的泰国 FRAX®评分低估了 7.8%患者的骨折风险。结论：与脊髓损伤相关的骨质疏松症和脆性骨折在泰国慢性脊髓损伤患者中较为常见。本研究结果强调了对慢性脊髓损伤患者进行与脊髓损伤相关的骨质疏松症和脆性骨折监测的重要性，无论其种族如何。不考虑 BMD 值的 FRAX®评分可能会低估慢性脊髓损伤患者脆性骨折的风险。因此，需要进一步研究，使用先前研究和本研究中提出的危险因素，开发针对脊髓损伤的骨折风险评估工具。
