bone health

Following a spinal cord injury (SCI), people can experience bone loss and muscle atrophy. Bone density decreases from the point of injury, increasing the risk of osteoporosis and fractures. While the loss of bone density is one of the most common conditions following SCI, there are several ways to manage bone health and reduce risk.

What is Osteoporosis?

Osteoporosis is a condition where bone loss is more rapid than bone growth, causing a gradual thinning of the bone, making it more porous and susceptible to fractures and other injuries.

We all build bone density until around our mid-30s, and then as we age we lose bone density over time. With SCI, however, this process is much different than what is experienced by the process of aging. Bone loss generally begins at the point of injury and below. It can start to occur as soon as 6-weeks post-injury and plateaus two to three years post-injury.

Osteopenia is an intermediate condition where the bone is losing density and strength but has yet to reach the more fragile state of osteoporosis. Individuals with complete injury experience more bone loss than those with incomplete injury.

With SCI, osteoporosis occurs for many reasons, including disuse, sluggish blood flow, hormonal change, metabolic disturbances, and autonomic nervous system dysregulation.

Bone Fracture and Spinal Cord Injury

Osteopenia and osteoporosis also increase the risk of bone fracture. Each year, about 2-4% of the SCI population fractures a bone, and most fractures are at the bottom of the femur or the top of the tibia. The annual occurrence of bone fractures is approximately 1% for injuries sustained less than 10 years ago, and 4.6% annually for injuries that occurred more than 10 years ago.

Frequent causes of fractures include:

  • Falling from a wheelchair or shower chair
  • Bumping into objects or walls
  • Turning in bed
  • Other low impact range of motion activities.

A person also may not know how the fracture occurred. If you suspect you have a bone fracture, or have recently had a fall or accident, it’s important to be screened for a potential break.

Bone fractures need to heal properly, as they can cause other health problems and concerns if left untreated. There are surgical and non-surgical options to treat bone fractures, and a medical professional can determine which one is optimum based on your particular injury.

Preventing Bone Loss and Injury

While there is currently no treatment to prevent bone loss in individuals with SCI, there are several things to bear in mind to minimize the extent of bone loss and improve bone strength as much as possible.

Proper nutrition: Eat a balanced and healthy diet that includes plenty of healthy protein, calcium, fruits, and vegetables.

Don’t Smoke: Smoking dramatically increases bone loss, so if you smoke it’s important to quit.

Limit Alcohol and Caffeine: Alcohol and caffeine also increase bone loss and impact bone strength, so avoid or limit consumption.

Regular Exercise: Exercise strengthens muscles and promotes overall fitness.

Prevent Falls and Accidents:  Make sure your wheelchair is properly positioned and fits well, all transfer techniques are safe, keep all equipment well maintained, and keep your environment as safe as possible to avoid falls. Keep hallways and doorways free from obstacles.

Vitamin D: Individuals with SCI are typically deficient in Vitamin D, which increases the risk and symptoms of osteoporosis. Incorporate foods high in Vitamin D, such as fatty fish, egg yolks and cheese. If you need to raise your vitamin D levels, consult your doctor about adding Vitamin D supplements to your daily routine.

Calcium: Supplementing with calcium alone will not prevent osteoporosis. It is recommended to take 1000-1500 mg/day. Discuss with your doctor to determine the appropriate dose for you.

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Sources:

http://sci.washington.edu/info/forums/reports/osteoporosis.asp

https://www.medpagetoday.com/resource-centers/osteoporosis/management-osteoporosis-and-fractures-following-spinal-cord-injury/493

https://www.spinalcord.com/bone-density-after-sci

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