- Focus on Secondary Condition Prevention: Pain is a Major Secondary Condition Among People with Spinal Cord Injury
- Spinal Cord Injury
- Metabolic and cardiopulmonary responses to acute progressive resistive exercise in a person with C4 spinal cord injury.
- Effect of a Holistic Health Promotion Program on Individuals with Spinal Cord Injury
- Long-term exercise training in persons with spinal cord injury: effects on strength, arm ergometry performance and psychological well-being.
- Blood pressure and heart rate response to isometric exercise: The effect of spinal cord injury in humans.
- Focus on Secondary Condition Prevention: Using Evidence-Based Physical Activity Guidelines to Reduce Secondary Conditions in People with Spinal Cord Injury
- Focus on Secondary Condition Prevention: Osteoporosis Risk and Low Bone Mineral Density in Children with Disabilities
- Focus on Secondary Condition Prevention: Osteoporosis Risk and Low Bone Mineral Density for People with Disabilities
- Review of Effectiveness of Physical Interventions for SCI
- A Protective Prescription for Individuals with Spinal Cord Injuries
- Gyms Need a Higher Level of Technology To Reach People with Disabilities
- Feeling Good: Exercising with Spinal Cord Injury
- Pilates for Individuals with Spinal Cord Injury
- Exercise Program for Individuals with Spinal Cord Injuries: Tetraplegia VHS/DVD & Quick Series Booklet
- Focus on Secondary Condition Prevention: Osteoporosis Risk and Low Bone Mineral Density in People with Developmental Disabilities
- Exercise Program for Individuals with Spinal Cord Injuries: Paraplegia - Video & Quick Series Booklet
- Osteoporosis and Nutrition
- More Vegetables for Healthy Bones?
- Exercise Induced Change in Psychological Well-Being among Spinal Cord Injury
- Physical Activity and Bone Health: Strategies for Exercise Prescription and Osteoporosis
- Assessment of holistic wellness program for persons with spinal cord injury
The following is Part II of a series of columns on the topic of osteoporosis in people with disabilities. This month's column is focusing on people with spinal cord injury.
|Jennifer Rowland, Ph.D.|
Osteoporosis Risk in People with Spinal Cord Injury
Physical mobility and weight bearing limitations for some people with disabilities make them more likely to experience osteoporosis than the general population. Osteoporosis is a major complication in people with spinal cord injury (SCI; Biering-Sorensen et al., 1998), and this population experiences lower limb bone loss and increased fracture susceptibility (Bauman et al., 2006; Biering-Sorensen, Bohr, & Schaadt, 1998; Garland et al., 1992). Factors influencing bone mass for people with SCI include: severity of injury, muscle spasticity, age, gender, and duration after injury (Jiang, Dai, & Jiang, 2006). An identical twin study comparing bone mineral density for one twin with SCI and the other without SCI found that over time there was an increasing loss of bone mineral content and density in the lower limbs and pelvis of the twin with SCI (Bauman et al., 1999). There is also evidence that women with spinal cord injuries have rapid bone loss of 25-50% in the lower extremities within the first few years following their injury.
Within the first months post-injury, weight-bearing bone structures including the distal femur and proximal tibia are primarily affected by demineralization (Nance et al., 1999). The imbalance between bone formation and bone resorption, beginning immediately after injury and peaking within 3-5 months post-injury, is responsible for bone loss for people with SCI. It is thought that approximately 2 years post-injury, a new steady state level of bone resorption and formation is established which alters bone structure and microstructure. This restructuring is believed to contribute to fracture risk (Jiang et al., 2006).
Although mobility limitations and disuse affecting mechanical force applied to bone (Zerwekh et al., 1998) are thought to be primary contributors to osteoporosis for people with SCI, some researchers postulate that neural factors may impair calcium and phosphate metabolism (Jiang et al., 2006). Associated hormonal deficiences (Bauman et al., 1994) and bone circulation problems linked to the injury may also be contributors to increased osteoporosis risk for this population (Chantraine et al., 1979). Little is known about the exact cause of osteoporosis in this population, and future research and treatments will need to focus on this issue.
Next month, I'll discuss two primary therapeutic approaches tested in experimental and clinical studies on the SCI population that involve application of mechanical stimulus to bone tissue and determination of the effects of antiresorptive drugs.
Continuing next month, this series of osteoporosis columns will provide information on osteoporosis risk for people with other types of physical and cognitive disabilities in addition to prevention recommendations, examination of intervention research focusing on prevention and treatment efforts, and an overview of medical treatment options.
Questions from Column Readers
Thank you for your questions and comments relating to last month's Part I column discussing osteoporosis as a secondary condition. Several people wrote to me asking for information about the effects of Fosomax on jaw bone health. I am in the process of gathering information about this issue and will answer this question in addition to the many thoughtful responses from other readers. Your feedback is important and stimulates dialogue which can be part of an effort to provide information and resources to decrease secondary conditions for people with disabilities.
I encourage you to write to me with suggestions for future column topics or to comment on the information provided in this column. You can reach me, Dr. Jennifer L. Rowland, by e-mail at email@example.com or (312) 413-1850.