Bone Health & Fracture

• Low trauma fractures, especially around the knee, are common in people with SCI.
• Bone health management should begin early following SCI as there is a significant decline in lower extremity BMD in the first year and the efficacy of drug interventions appear to be most effective with a shorter time period between injury onset and drug administration
• Measurement and monitoring of hip and knee region BMD after SCI are essential to identify low bone mass and quantify lower extremity fracture risk.

Pharmacologic Therapy for Prevention of SLOP

• Oral Tiludronate and Clodronate prevent a decrease in BMD of the hip and knee region with no adverse effects on bone mineralization in men with paraplegia.
• Oral Etidronate prevents a decrease in BMD of the hip and knee region in people with AIS D paraplegia or tetraplegia.
• Once weekly oral Alendronate maintains BMD at the hip in men and women with AIS A-C paraplegia.
• Once yearly IV infusion Zoledronate does not maintain hip BMD at 12 months in men and women with AIS A or B paraplegia or tetraplegia.
• Pamidronate 30 mg IV or 60 mg IV 4x/year is not effective for the prevention of BMD loss at the hip and knee region early after SCI people with AIS A paraplegia or tetraplegia.
• In summary, there is limited evidence that bisphosphonates prevent hip and knee region BMD decline after SCI, although they are moderately effective for reducing the rate of bone resorption and degree of BMD decline in the hip and knee region.

Pharmacologic Therapy for Treatment of SLOP

• Alendronate 10 mg daily and Calcium 500 mg orally 3x/day is effective for the maintenance of BMD of the total body, hip and knee region for men with paraplegia.
• Vitamin D analog is effective for maintenance of BMD in the leg.
• Short term (6 weeks) therapeutic ultrasound is not effective for preventing bone loss after SCI.

Non-pharmacologic Therapy for Prevention and/or Treatment

• FES-cycling does not improve or maintain bone at the tibial midshaft in the acute phase but may increase/maintain lower extremity BMD the longer time since injury.
• Electrical stimulation can maintain or increase BMD over the stimulated areas.
• There is inconclusive evidence for Reciprocating Gait Orthosis, long leg braces, passive standing or self-reported physical activity as a treatment for low bone mass.
• There is a lack of definitive evidence supporting non-pharmacological interventions for either prevention or treatment of bone loss after a SCI.