Kivimaki & Ahoniemi 2008;

Finland

Downs & Black = 23

Cross-sectional with AB control

N SCI = 120

N controls = 103

Population: 120 SCI subjects at least 3 months post-injury (54 paraplegic, 66 tetraplegic, age 18-65), and 103 AB control subjects

Methodology: Comparison of shoulders

Outcome Measures: Ultrasonography; on the acromioclavicular joint, the supraspinatus tendon, bicipitus longus tendon and the tendon sheath, posterior glenohumeral joing space; performance-corrected Wheelchair User's Shoulder Pain Index (PC-WUSPI)

1. Osteophytes noted in 14% of AB, 22% of paraplegic, and 26% of tetraplegic subjects; mean acromioclavicular joint space was 4.0±1.2 mm in AB and 3.7±1.3 mm in subjects with SCI.
2. The mean thickness of the bicipitus tendon sheath was 4.0±0.5 mm in AB and 4.5±1.4 mm in subjects with SCI.
3. Glenohumeral effusion was noted in 6% of subjects who use no assistive device, 27% of those using manual wheelchairs, and 25% using electric wheelchairs.
4. Frequency of effusion increased with age; shoulder pain was related to effusion in subjects with paraplegia. 

Siddall et al. 2003;

Australia

Downs & Black =18

Longitudinal

N=73

Population: 60 males and 13 females; mean age at baseline 40 (21 – 81 yrs); mean time post-injury at baseline < 6 mos

Methodology: Assessed the prevalence, onset, and severity of pain at less than 1 YPI and at 5 YPI

Outcome Measures: Pain intensity via numeric scale; Psychological distress; Von Korff chronic pain disability to assess pain interference on daily activities; assessed at less than 1 YPI and again at 5 YPI  

1. Mean onset for musculoskeletal pain was at 1.3 + 1.7 yrs, with a high prevalence at 5 yrs with an initial decline in the first 6 most post-injury.

Frotzler et al. 2008;

Switzerland

Downs & Black = 16

Longitudinal

N=39

Population: 39 SCI subjects, 28 paraplegic, 11 tetraplegic, ASIA A and B, mean age 42.0±13.4 yrs (range 21-64), 0.9-34 YPI (mean 12.0±10.8)

Methodology: To evaluate changes in bone mineral density (BMD) of distal epiphyses and midshafts of femur, tibia

Outcome Measures: Bone measures by pQCT in the radius of the non-dominant arm and the tibia and femur of the opposite leg at baseline, 15 months, and 30 months.

1. No significant difference in any measurements in the femur (77.9% of scams show no change, 12.3% show decrease, and 9.7% show increase) or the tibia (69.4% show no change, 19.0% show decrease, and 11.6% show increase).
2. Changes in the radius bone were not related to changes in the tibia or the femur.
3. Neither time post-injury nor age was significant covariates for the tibial and femoral bone parameters.
4. Data show that there is initially a large decrease in bone parameters post-injury but reaches a steady-state after 3-8 yrs.

Akbar et al. 2010;

Germany

Downs & Black = 15

Cross-sectional with AB controls

SCI N = 100

(N controls = 100)

Population: 72 males and 28 females with paraplegia; SCI level T2-L3; mean age 52 ±9 yrs (range 29-70); mean YPI 33.7 (range 29-48 yrs); wheel chair dependent for minimum 30years; body mass index <40; no active shoulder infection; no previous upper extremity surgery; 100 age and gender matched AB controls 

Methodology: Comparison shoulder function, pain and prevalence of rotator cuff tears between individuals with paraplegia with at least 30 years experience with using a wheelchair and an age and sex matched control group.

Outcome Measures: MRI, shoulder function (Constant score), pain (visual analog scale). 

1. Shoulder function was significantly worse in the group with paraplegia compared to the AB control group.
2. Pain scores were signifcanlty worse in the group with paraplegia.
3. The prevalence of rotator cuff tears was significantly higher in the group with paraplegia.

Jensen et al. 2005; USADowns & Black =14 N = 147 Longitudinal

Population: 110 males and 37 females; mean age at follow-up 48.8 + 13.0 (21 – 88 yrs); mean YPI at follow-up 16.6 + 10.4 (3.2 – 57.4 yrs).

Methodology:  Examine the change in the prevalence and intensity of pain over time

Outcome Measures: Brief Pain Inventory Interference scale; Bodily Pain scale; SF-36; Mental Health scale (range of 2-6 years between assessments)

1. A larger number of participants reported an ↑ (p < 0.001) in shoulder pain over time.

Frey-Rindova et al. 2000; Switzerland Downs & Black = 14 Longitudinal N = 29

Population: 27 males and 2 females; age range 19 – 57 yrs.

Methodology: To evaluate changes in Trabecular and cortical bone mineral density (BMD)

Outcome Measures: Trabecular and cortical BMD, evaluated at 1, 6, 12, and 24 months past injury

1. Trabecular BMD of radius and ulna ↓ in persons with tetraplegia at 6 months (radius 19% less, p < 0.01; ulna 6% less, p < 0.05), and at 12 months (radius 28% less, p < 0.01; ulna 15% less, p < 0.05) post- injury.
2. Cortical BMD of radius and ulna ↓ in persons with tetraplegia at 12 months (radius 3% less, p < 0.05; ulna 4% less, p < 0.05) post-injury.
3. Trabecular BMD of tibia was ↓ 6 months (5% less, p < 0.05), and 12 months (15%, p < 0.05) post-injury.

Eser et al. 2004;

Switzerland

Downs & Black = 14

Cross-sectional with AB controls

N SCI = 89

N controls = 21

Population: All males; mean age 41.5 + 14.2 (range 10-65 yrs); mean YPI 29.3 + 12.5 (range 2 mos-50 yrs); age and gender matched AB controls

Methodology: Comparison of bone mineral density of distal epiphyses and midshafts of femur, tibia, and radius

1. 1. Group with SCI had ↓ BMD (p < 0.0001) than the AB control group.

Szoller et al. 1997b;

USA

Downs & Black = 13

Cross-sectional with AB controls

N SCI = 263

N controls = 92

Population:  All males with SCI; mean age 48.8 + 1.3 (20 – 78 yrs); YPI range 0.8 to 53 yrs; age and gender matched AB controls

Methodology:  Comparison of bone mineral density (BMD) of the lumbar spine, femoral neck, Ward’s triangle, and the greater trochanter with AB controls

1. Lumbar spine BMD was stable with a nonsignificant ↓ in persons with tetraplegia at 1-5 YPI in the 20-39 yr. old group.  Lumbar spine BMD maintained in all other SCI groups, increasing with age, regardless of age at injury or level of injury.
2. Persons injured less than 1 yr. had comparable BMD to AB controls.
3. Persons aged 20-39 yrs. old who were injured more than 1 YPI had ↓ (p < 0.01) BMD in the femoral region than AB matched controls and 20-39 yr. olds injured less than 1 YPI.

Petrofsky & Laymon 2002;

USA

Downs & Black = 13

Cross-sectional with AB controls

N SCI = 50

N controls = 50

Population: 50 able-bodied (AB) male controls and 50 males with paraplegia (T4 complete, 3-10 YPI), ages 20-65 yrs, age-, height-, and weight-matched.

Methodology: Both groups were stratified according to age and compared.

1. Handgrip strength ↑ in subjects with paraplegia than controls (avg 589 N vs. 463 N; quadriceps extension strength ↑ in controls (avg 696 N vs. 190 N) with decreases with age in both groups.
2. Leg endurance ↓ in group with paraplegia but handgrip endurance was similar in both groups with endurance increases with age in both groups.
3. Resting BP ↑ with age in both groups.
4. Magnitude of pressor response to exercise ↑ with age in both groups.
5. HR remained constant with age in both groups in response to quadriceps contractions; ↓50% between ages 20-60 yrs in both groups for handgrip exercise.

de Bruin et al. 2000; Switzerland Downs & Black = 13
Longitudinal N SCI = 12

Population: All males; mean age 32.4 + 9 (23-50 yrs) at follow-up

Methodology: Monitoring changes in structural and geometric properties of the tibia and cortical bone

Outcome Measures: Structual and geometric properties of the tibia and cortical bone, assessed at 5 weeks post-injury and again at approx. 2 YPI

1. Trabecular and cortical bone, and geometric properties of tibia bone ↓ (p < 0.05) within 2 YPI.
2. Phase velocity propagation changed in swing tibia bone in 3 participants within 2 YPI.

Garland et al. 2004; USA Downs & Black = 13 Longitudinal N = 6

Population: 6 patients (1 female) with complete paraplegia and 1 with L1 incomplete paraplegia ages 24.4 + 3.9.

Methodology:Bone mineral density (BMD) measured from proximal to distal sites assessed at 33.5 and 523 days post-injury.

Outcome Measures:Dual-energy X-ray absorptiometry (DXA) and ultrasound (US).

1. BMD of os calcis significantly ↓ 38% by DEXA and 48% by US.
2. BMD of knee, distal femur, and proximal tibia significantly ↓ by 24%, 27%, and 32% respectively.

Rittweger et al. 2010;

Germany

Downs & Black = 12

Cross-sectional with AB controls 

N SCI = 9

N controls = 9

Population: 9 males with SCI (lesions between L1 and T5, 8 motor complete, 1  motor incomplete); mean YPI 21.4 (range 9-32); mean age 21.4 years (range 17-35 years); 9 age-height-weight matched AB controls

Methodology: Comparison of the total mineral bone content in the tibia of SCI participants and AB controls.

Outcome Measures: Serial tomographic scans performed sequentially in steps of 5% of the tibia length from distal to proximal.

1. Individuals with SCI had lower total bone mineral content than their AB counterparts (p<0.001 at all scanned sites).
2. Differences were more pronounced at the distal and proximal regions than at the shaft regions of the tibia (p<0.001). 

de Bruin et al. 2005; Switzerland Downs & Black = 12 Longitudinal N =10

Population: 9 males and 1 female; mean age 40.9 + 19.7 (range 19-81 yrs) at follow-up

Methodology: Comparison of trabecular and compact bone mineral density (BMD) of tibia and radius at 5 weeks post-injury and at approx. 3.5 YPI

Outcome Measures: Trabecular and compact BMD

1. Trabecular tibia and compact bone ↓ (p < 0.05) within 3.5 YPI
2. No changes in radius trabecular bone were observed.
3. Patterns suggest no steady state of bone BMD following 3 YPI.

Dudley-Javoroski & Shields 2010;

USA

Downs & Black = 12

Mixed Cross-sectional/longitudinal

N SCI = 15

N control = 10

Population: 15 individuals (14 males and 1 female) with SCI; age at SCI (range 18-49 yrs); 10 age and stature (femur length) matched AB controls (9 males and 1 female)

Methodology: Comparison of BMD of the femur metaphysis (12% of length from distal end) by using pQCT imaging over two years.

1. The BMD of individuals with SCI was 1 standard deviation below the control groups BMD at 1.5 years and 2 standard deviations below at 2 years.
2. In the first two years after SCI, individuals with SCI lost an average of 1.7% of the initial BMD per month.

Dionyssiotis et al. 2011;

Greece

Downs & Black = 12

Cross-sectional comparative study

N SCI = 31

N controls = 30

Population: 31 males with complete paraplegia (AIS A) ; >1.5 years post injury; 16 in Subgroup A (T4-T7, mean age 32.88±15.6 yrs) and 15 in Subgroup B (T8-T12, mean age 39.47±13.81 yrs); 30 age-height-weight-gender matched AB controls; mean age 33.9±3.81 yrs

Methodology: Comparison of the influence of positive (spasticity, standing-therapeutic walking), and negative factors (duration of paralysis) on bone structures between groups using pQCT measurement

1. All BMD parameters were significantly reduced for individuals with paraplegia compared to the control group
2. Individuals with SCI who used standing frames or long brace orthoses had statistically higher BMD trabecular (141.60±59.71 vs. 87.4±47.23  mg/cm3, p=0.03), BMD total (796±54 vs. 700±132 mg/cm3, p=0.01), and cortical thickness (4.98±0.52 vs. 4.12±1.16mm, p=0.013) compared to individuals with SCI who used wheelchairs
3. Duration of SCI was significantly related to trabecular bone loss and cortical thickness in both SCI groups

Pentland & Twomey 1994;

Canada

Downs & Black = 12

Cross-sectional with AB controls

N SCI = 52

N controls = 52

Population: 52 males with complete paraplegia (T2-L5, mean age 44 yrs, mean 17 years post-injury) and 52 age- and activity level-matched able-bodied (AB) males.

Methodology: Bilateral upper limb physical functions were compared between the paraplegic and able bodied groups.

1. AB had greater bilateral shoulder flexion and SCI greater bilateral elbow extension.
2. Impairment and activity level were better predictors of strength in 9/14 muscles tested, whereas age was a better predictor in AB group.
3. Shoulder pain related to time since injury, not age; pain experienced by majority of subjects with paraplegia (58-60%).

Wilmet et al. 1995;

Belgium

Downs & Black = 11 Longitudinal

N SCI = 31

Population: 31 patients (24 males) with T2 – L3 paraplegia ages 32.5 (17.5 to 65.5 years).

Methodology:Total body and regional bone mineral content (BMC) and soft-tissue composition assessed at 5, 10, 20, 30, 40, and 50 weeks post-injury.

Outcome Measures:Dual-energy X-ray absorptiometry (DXA) and soft tissue phantom.

1. Rapid BMC ↓ in paralyzed areas of approx. 4% per month in trabecular bone and approx. 2% per month in areas with mainly compact bone.
2. Lean muscle mass ↓ during first months post-injury in the legs while fat content ↑.

Kiratli et al. 2000;

USA

Downs & Black = 11

Cross-sectional with AB controls

N SCI = 246

N controls = 188

Population: 239 males and 7 females; age range 21-78 yrs; YPI range 0.1-51 yrs

Methodology: Comparison of bone mineral density (BMD) throughout the femur and geometric properties at the femoral midshaft

1. SCI group had ↓ BMD (p < 0.0001) in all femoral regions (27%, 25%, and 43% for femoral neck, midshaft, and distal femur, respectively). 
2. Group with SCI were ↓ (p < 0.0001) in cortical area of femoral midshaft.

Garland et al. 2001b;

USA

Downs & Black = 11

Cross-sectional with AB controls

N SCI = 31

N controls = 17

Population: 31 women with complete SCI mean age 43.9 + 19.7 and mean 16.9 + 7.7 years post-injury; 17 able-bodied age-matched women mean age 44.7 + 2.5.

Methodology:Bone mineral density (BMD) measured from lumbar spine, hip, and knee.

1. BMD of spine in persons with SCI was maintained or significantly ↑ compared to age-matched controls.
2. BMD of hips and knee in persons with SCI was significantly ↓ compared to controls. 

Vlychou et al. 2003;

Greece

Downs & Black = 11

Cross-sectional with AB controls

N SCI = 57

N controls = 92

Population: 33 males and 24 females with paraplegia, mean age 37.8 (range 21 – 66 yrs); YPI range 6 months - 27 yrs; age and gender-matched AB controls

Methodology: Comparison of bone mineral density (BMD) of the proximal and distal forearm, the femoral neck, the greater trochanter, and Ward’s triangle

1. Group with SCI had ↓ BMD of femoral neck (p < 0.001 – male, p < 0.001 – female), greater trochanter (p< 0.001 and p = 0.001), and Ward’s triangle (p =0.001 and p = 0.005).
2. Among males, 23.3% ↓ in femoral neck, 22.5% ↓ in greater trochanter, and 20.8% ↓ in Ward’s triangle compared to AB controls.  In females, ↓ were 24.1%, 24.3%, and 24.2%.

Szollar et al. 1997a;

USA

Downs & Black = 11

Cross-sectional with AB controls

N SCI = 135

Population: Able-bodied (AB) individuals ages 24-76, mean 51.1 ±1.7 years; SCI patients’ ages 20-78 years, mean 48.8±1.3 years.

Methodology: Both groups were stratified according to age and compared; SCI patients were grouped according to neurologic group within the various age categories.

1. Lumbar spine BMD of the 40-59 year old and the 60+ patients were significantly ↑ (p ≤0.012) than AB counterparts
2. Femoral region BMD of the 20-39 year old and 40-59 year old patients were all significantly ↓ (p ≤0.027) than AB counterparts
3. Hip region BMD loss occurred starting at 1 years post-injury, plateaus at 19 years post-injury and then improves.
4. Spine BMD in patients never ↓significantly and started ↑ as YPI ↑.
5. Femoral neck and Ward’s triangle BMD ↓ after 1 year post-injury. After 19 years post-injury, slight ↑ in both regions. 

Szollar et al. 1998;

USA

Downs & Black =11

Cross-sectional with AB controls

N SCI = 176

Population: All males with SCI; mean age 41.2 (20 – 59 yrs); YPI range 0.8 to 34 yrs.

Methodology: Comparison of bone mineral density (BMD), serum levels of calcium, calcitonin, biochemical markers of bone formation, and parathyroid hormone (PTH)

1. Spine BMD remained stable above fracture threshold in the 20-39 yr. and in the 30-49 yr. age groups.
2. In all groups, there was progressive ↓ in BMD at proximal femur, and began 1-9 YPI. For the 20-39 yr. age group, this was significant for all three areas. For the 30-49 yr. age group, this progressed at a slower rate, reaching threshold at 10-19 YPI for all three areas.
3. PTH levels remained below the reference range, with a slight gradual ↑ after 1 YPI. Results suggest parathyroid dysfunction- related osteoporosis.

Finsen et al. 1992;

Norway

Downs & Black =11

Cross-sectional with AB controls

N SCI = 19

Population:  All males with SCI; median age at injury 20 (range 15 – 64 yrs); median YPI 4 yrs (range 7 months – 33 yrs); age and gender matched AB controls

Methodology:  Comparison of bone mineral density (BMD) of lower and upper extremities, and of biochemical and bone markers

1. SCI group had ↓ in metaphysis (45%; p = 0.0001) and diaphysis (26%; p = 0.0001) of tibia, while a barely significant difference of distal forearm was detected (diaphysis; p = 0.0418; metaphysic; p= 0.1611).
2. SCI group had ↓ levels of serum creatinine (p = 0.0001), and ↑ levels of alanine aminotransferase (p = 0.007), serum phosphate (p = 0.014), follicle stimulating hormone (p = 0.016), and sex hormone binding globulin (SHGB; p = 0.009). 
3. Total testosterone was equivalent but when divided by SHGB, ↑ p = 0.011) in group with SCI.

Bauman et al. 1999;

USA

Downs & Black = 11

Cross-sectional with AB control

N SCI = 8

Population: Able-bodied (AB) twins of 8 males with SCI with complete paraplegia ages 40.4 + 10, 16 + 9 years post-injury.

Methodology:Bone mineral content (BMC) and density (BMD) for total and regional skeletal bone mass.

1. Compared to twin controls, persons with SCI had significantly ↓ BMC, with predominant sites being the legs and pelvis.
2. Duration of SCI, not age was associated to degree of leg bone loss in twin with SCI.

Slade et al. 2005;

USA

Downs & Black = 11

Cross-sectional with AB controls

N SCI = 19

Population: 19 women with complete SCI;  mean age of premenopausal (< 30 yrs) 23.0 + 2.55 yrs; mean YPI 5.6 + 2.33 yrs, mean age of premenopausal (>35 yrs) 42.6 + 4.66 yrs;  mean YPI 12.2 + 8.14 yrs;  mean age of post-menopausal 54.5 + 7.7 yrs; mean YPI 14.17 + 11.9 yrs; 17 age and gender matched AB controls

Methodology: Comparison of the trabecular bone of the knee

1. SCI group: trabecular bone was significantly ↓ compared to AB controls.
2. SCI groups had fewer (-19 and -26% less) and thinner trabeculae (-6%) that were spaced further apart (40% and 62% more space between structures) resulting in less trabecular bone volume (-22% and -33%) compared to AB controls.

Garland et al. 1992;

USA

Downs & Black =10 Longitudinal

N = 45

Population: All males with complete SCI; mean age 28.1 + 0.78 yrs – 25; mean days post-injury 114.1 + 8.6

Methodology: Assessment of TBM and BMD at different times post-injury

Outcome Measures: Total bone mass (TBM), and bone mineral density (BMD), assessed at 114.1+8.6 days post-injury and again at 468.9+21 days post-injury

1. TBM of the pelvis and legs ↓ (p < 0.0001) between initial and follow-up assessment.
2. BMD of the distal femur (p <.0001) and proximal tibia (p < 0.001) ↓ between initial and follow-up assessment.

Giangregorio et al. 2005;

Canada

Downs & Black = 10

Cross-sectional with AB controls

N SCI = 2

Population: Both females; Twin pair 1 (TP1) – mean age 32 yrs; mean YPI 7 yrs; C7 complete tetraplegia; Twin pair 2 (TP2) – mean age 47 yrs; mean YPI 20 yrs;  T8 paraplegia.

Methodology: Comparison of bone mineral density (BMD), bone geometry, and muscle cross-sectional area (CSA) with monozygotic twin.

1. TP1: Twin with SCI, BMD of hip, distal femur, proximal tibia, and spine were 59.5 46.6, 53.1, and 93.3%, respectively, of AB control.
2. TP2: Twin with SCI, BMD of hip, distal femur, proximal tibia, and spine were 36.2 35.9, 39.2, and 62.2%, respectively, of AB twin control.

Dauty et al. 2000;

France

Downs & Black =10

Cross-sectional with AB controls

N SCI = 31

Population: All males with SCI; mean age 36 + 12.3 (range 18 – 60 yrs); mean YPI 6 (6 months – 19 yrs); age and gender matched AB controls

Methodology: Comparison of supra- and sublesional bone mineral density (BMD) and bone mineral content (BMC), and of blood and urine samples that included phosphocalcic parameters with determination of urinary hydroxyproline and deoxypyridinoline

1. SCI group had a ↓ (p < 0.0001) of sublesional BMD of 41% compared to AB controls.  This loss of mass is ↑ at the distal femur (-52%) and proximal tibia (-70%).
2. SCI group had ↓ BMD at the femoral neck (30%, p< 0.0001) and at the trochanter (39%, p < 0.0001) compared to AB controls.  Also had ↓ BMC in lower limb (48%, p < 0.0001) and pelvis (55%, p < 0.0001).
3. Blood phosphate level and urinary phosphate level were ↑ (p < 0.01) in group with SCI compared to AB controls.  Urinary levels of calcium (p < 0.001), hydroxyproline (p < 0.0001), and deoxypiridoline (p < 0.01) are ↑ in group with SCI compared to AB controls.

Bauman et al. 1995;

USA

Downs & Black =10

Cross-sectional with AB controls

N SCI = 100

Population: All males with SCI,  mean age 51 + 14 yrs; mean YPI 20 + 13 (range 1 – 48 yrs); 50 age and gender matched controls

Methodology: Comparison of serum calcium (Ca), phosphorus (PO4), albumin, alkaline phosphatase (Alk P), and parathyroid hormone (PTH) with serum 25-hydroxyvitamin D [25(OH)D]

1. Approximately ⅓ of group with SCI were vitamin D deficient, which was a ↑ (p = 0.05) percentage than AB controls.
2. Mean serum 25(OH) D was ↑ (p < 0.0005) in group with SCI compared to AB controls.

Chow et al. 1996;

United Kingdom

Downs & Black = 9

Cross-sectional with AB controls

N SCI = 31

Population: 19 males and 12 females with SCI, age range 19 – 60 yrs; mean YPI 5.87 + 10.21 (range 5 wks – 36 yrs); age and gender matched AB reference population

Methodology: Comparison of bone mineral density (BMD) of right heal, lumbar spine, and proximal femur region (femoral neck, Ward’s triangle, trochanteric and inter-trochanteric), and of bonestructure (stiffness)

1. Ultrasonic properties at the calcaneus were ↓ (p < 0.05) in group with SCI.
2. After 1 YPI, BMD in femoral neck ↓ (p < 0.05) in group with SCI compared to AB reference population.

Vaziri et al. 1994;

USA

Downs & Black =9

Cross-sectional with AB controls

N SCI = 40

Population:  All males with SCI; age range 25 – 69 yrs; YPI range 3 – 50 yrs

Methodology:  Comparison of serum levels of parathormone (PTH), calcitonin, vitamin D (calcitriol), 25 hydroxy (OH) vitamin D, 1,25 (OH)2 , ionized calcium (Ca++), and phosphorous

1. Plasma PTH was ↓ in group with SCI (p <0.001) compared to AB controls, despite equivalent concentrations of Ca++.
2. Plasma calcitrol was ↓ in group with SCI (p < 0.05) compared to AB controls, and ↓ in persons with tetraplegia vs. those with paraplegia (p<0.05).

Amsters & Nitz, 2006;

Australia

Downs & Black = 8

Cross-sectional with AB controls

N SCI = 30

Population: All males with tetraplegia, divded into four groups (age > 50 yrs & YPI< 5 yrs; age < 40 yrs & YPI < 5yrs; age > 50 yrs & YPI > 15 yrs; age < 40 yrs & YPI > 15 yrs); age and gender matched AB controls

Methodology: Comparison of posture

1. Group with SCI had ↑ thoracic kyphosis (p < 0.05) than AB controls.
2. Regardless of age and duration of injury, persons with SCI do not sit with greater pelvic tilt than AB controls.

Catz et al. 1992;

Israel

Downs & Black = 7 Longitudinal N = 9

Population: 9 C3-T11 paraparetic patients; Age at enrollment: mean 37.5 years, range 24-67.  Able-bodied controls from another study.

Methodology: Lumbar spine dimensions assessed twice over 10 year interval.  

Outcome Measures: Lumbar anteroposterior (AP) radiographs.

1. The normal aging process, including the horizontal spreading of the lumbar vertebral bodies and narrowing of the lumbar spinal canal, is not accelerated by paraparesis and may be retarded by relative immobilization.

Lal 1998; USA Downs & Black =7 Longitudinal N = 53

Population: 35 males and 18 females; mean age 37 (range 19-81 yrs) at baseline

Methodology: Monitoring incidence of degenerative shoulder changes

Outcome Measures: Incidence of degenerative shoulder changes, accessed through X-ray at baseline and every 2 years after until 5-15 YPI

1. 72% of sample demonstrated radiological evidence of degenerative changes, but only 11% reported shoulder pain.
2. Persons with ↑ age (< 30 yrs) had ↑ incidence of radiographic changes.
3. Premature shoulder changes appear primarily in wheelchair users of advanced age in less than 10 yrs with predilection of Acromioclavicular joint.

Biering-Sorenson et al. 1990;

Denmark Downs & Black = 7 Longitudinal

N SCI = 8

Population: 8 patients (6 male)  with complete paraplegia and 1 with L1 incomplete paraplegia ages 24.4 + 3.9

Methodology:Bone mineral content (BMC) from lumbar spine, femoral neck and shaft, proximal tibia and distal forearm assessed at 43 days, and 5-13 up to 31-53 months post -injury.

Outcome Measures:Dual photon absorptiometry (DPA).

1. Lumbar spine and distal forearm BMC in pts did not change.
2. BMC in lower extremities (femoral bone and proximal tibia) ↓.