Antoniou Georgia, Benetos Ioannis S, Vlamis John, Pneumaticos Spyros G
Orthopaedics, Evangelismos General Hospital, Athens, GRC.
Orthopaedics, KAT Attica General Hospital, Athens, GRC.
Cureus. 2022 Mar 23;14(3):e23434. doi: 10.7759/cureus.23434. eCollection 2022 Mar.
Spinal cord injury (SCI) causes rapid osteoporosis below the level of injury in a multi-factorial manner. This literature review focused on the early diagnosis of low bone mass (LBM) in SCI patients and aimed to summarize all the available recent data on the diagnosis and treatment of osteoporosis in this unique patient population. Materials and Methods: Advanced literature research was conducted in the online PubMed database using the keywords 'bone mineral density, 'spinal cord injury, 'skeletal fragility', and 'osteoporotic fractures'. Out of the initial 430 articles, duplicates were removed and the remaining studies were assessed for eligibility. Two reviewers independently extracted data from each study and assessed variable reporting of outcome data. The exclusion criteria were: studies not measuring bone mineral density (BMD), studies comparing SCI to other diseases, animal studies, molecular studies, studies including children, and studies not written in English. The 83 remaining papers were divided into studies focusing on treatment and studies investigating LBM in SCI. Following this step, studies with small patient samples set at 20 patients with SCI for the treatment group and 30 patients for the diagnosis of the LBM group, were also excluded.
In the remaining 32 studies, 18 focused on the diagnosis of LBM in SCI and 14 focused on the various treatment options to address this phenomenon. Most of these studies (n=13) used the dual-energy X-ray absorptiometry (DXA) method to evaluate bone mass while five studies preferred quantitative computed tomography (QCT) measurements and one evaluated LBM using calcaneal qualitative ultrasound. In the treatment group of studies, seven papers administered medication to address LBM and four clinical protocols used physiotherapy methods to reduce bone loss post-SCI while three studies combined medical treatment with physiotherapy.
The unawareness of the unique mechanism through which bone is rapidly lost in the first months post-SCI led to initial scientific confusion. In this review, we summarize information to increase physicians' awareness of the dangers of 'silent' osteoporosis progression post-SCI. We have also provided information on the best timing to evaluate bone loss as well as treatment options that could prevent fragility fractures in this population.
脊髓损伤（SCI）以多因素方式导致损伤平面以下迅速发生骨质疏松。本综述聚焦于脊髓损伤患者低骨量（LBM）的早期诊断，旨在总结有关这一特殊患者群体骨质疏松诊断和治疗的所有最新可用数据。
在在线PubMed数据库中进行高级文献检索，使用关键词“骨密度”“脊髓损伤”“骨骼脆性”和“骨质疏松性骨折”。在最初的430篇文章中，去除重复项，并评估其余研究的 eligibility。两位审阅者独立从每项研究中提取数据，并评估结果数据的变量报告。排除标准为：未测量骨密度（BMD）的研究、将脊髓损伤与其他疾病进行比较的研究、动物研究、分子研究、纳入儿童的研究以及非英文撰写的研究。其余83篇论文分为关注治疗的研究和调查脊髓损伤患者低骨量的研究。在此步骤之后，治疗组样本量小（设定为20例脊髓损伤患者）以及低骨量诊断组样本量小（设定为30例患者）的研究也被排除。
在其余32项研究中，18项聚焦于脊髓损伤患者低骨量的诊断，14项聚焦于解决这一现象的各种治疗选择。这些研究中的大多数（n = 13）使用双能X线吸收法（DXA）评估骨量，而五项研究更倾向于定量计算机断层扫描（QCT）测量，一项使用跟骨定性超声评估低骨量。在治疗组研究中，七篇论文使用药物治疗低骨量，四项临床方案采用物理治疗方法减少脊髓损伤后的骨质流失，三项研究将药物治疗与物理治疗相结合。
对脊髓损伤后最初几个月骨骼迅速流失的独特机制缺乏认识导致了最初的科学困惑。在本综述中，我们总结信息以提高医生对脊髓损伤后“隐匿性”骨质疏松进展危险的认识。我们还提供了评估骨质流失的最佳时机以及可预防该人群脆性骨折的治疗选择的信息。
