title: Fracture rates and risk factors for fractures in patients with spinal cord injury.
abstract: OBJECTIVE
  To study fracture rates and risk factors for fractures in patients with spinal cord injuries.
  
  
  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.
authors.affiliation: Aarhus Bone and Mineral Research Group, Department of Endocrinology and Metabolism, Denmark.
authors.forename: P
authors.initials: P
authors.lastname: Vestergaard
authors.forename: K
authors.initials: K
authors.lastname: Krogh
authors.forename: L
authors.initials: L
authors.lastname: Rejnmark
authors.forename: L
authors.initials: L
authors.lastname: Mosekilde
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D015444:Exercise; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology* / Q000209:etiology*; D006801:Humans; D015994:Incidence; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D012307:Risk Factors; D017678:Sex Distribution; D013119:Spinal Cord Injuries / Q000150:complications*; D011795:Surveys and Questionnaires