Fracture rates and risk factors for fractures in patients with spinal cord injury.

AIM

To study fracture rates and risk factors for fractures in patients with spinal cord injuries.

MATERIAL AND METHODS

A self-administered questionnaire was mailed to 646 members of the Danish Paraplegic Association and 1000 randomly selected normal controls. 438 patients (309 males, 129 females, 67.8%) and 654 controls (332 males, 322 females, 65.4%) returned the questionnaire. Median age in patients was 42, range 10-80 years, and in controls 43, range 19-93 years (2p = 0.25).

RESULTS

The crude fracture rate was 2% per year in patients and 1% per year in controls (RR = 2.0, P < 0.001). Low-energy fractures were much more prominent in patients (19.0% of all fractures) than in controls (1.4%, P < 0.001). The fracture rate did not differ before the injury but increased after the injury to a constant level from the third year and forward. Fractures of the lower extremities were more prominent in patients than controls (femurs: RR = 23.4, P < 0.001, lower legs: RR = 5.2, P < 0.001, feet/toes: RR = 2.4, P = 0.006) while fractures of the forearms (P < 0.001) and clavicles (P = 0.03) were absent among patients. Fractures were more frequent in female patients (RR = 1.6, P = 0.008) and in male patients with a family history of fractures (RR = 2.0, P = 0.004).

CONCLUSIONS

Low-energy fractures especially of the lower extremities are frequent in spinal cord injury patients and especially among female patients. The forearms seem protected from fractures.