Paraplegia-related alterations of bone density in forearm and hip in Greek patients after spinal cord injury.
OBJECTIVE
Paraplegia due to spinal cord injury is related with sublesional bone demineralization with an increased incidence of pathologic fractures in lower extremities. This study was carried out in order to evaluate bone density alterations in forearm and hip in Greek paraplegic patients after spinal cord injury and to correlate the findings with the level of injury, the neurological status, the time interval from injury and the performing of physiotherapy and therapeutic standing.


METHODS
Fifty-seven paraplegic patients (33 men and 24 women, with injuries sustained from 6 months to 27 years) and 36 able-bodied age-matched controls (25 men, 16 women) participated in the study. Bone mineral density (BMD) was measured by dual X-ray absorptiometry (DXA) in the proximal and distal forearm, the femoral neck, the greater trochanter and Ward's triangle.


RESULTS
The measurements revealed a significant reduction of BMD of femoral neck (p<0.001 in male, p<0.001 in female paraplegics), greater trochanter (p<0.001 and p=0.001, respectively) and Ward's triangle (p=0.001 and p=0.005, respectively). Proximal forearm depicted non-significantly decreased BMD values and distal forearm depicted a slight increase in BMD values. The degree of demineralization was independent of factors such as complete or incomplete spinal cord injury, level of the lesion, physiotherapy and performing of standing. In addition to that, BMD values in both hip and forearm showed no statistically significant correlation with time after injury.


CONCLUSIONS
BMD measurements in Greek paraplegic patients reveal bone loss, which most dramatically occurs in the region of hip with a consequent increase of fracture risk. Forearm measurements depict a non-homogeneous response with limited proximal bone loss and slight distal increase of BMD, the latter being possibly attributed to daily activities.
Department of Radiology, National Institute of Rehabilitation, Ilion 13122, Greece. mvlychou@hol.gr
M
M
Vlychou
P J
PJ
Papadaki
G M
GM
Zavras
K
K
Vasiou
N
N
Kelekis
K N
KN
Malizos
I B
IB
Fezoulidis
D000328:Adult; D018488:Bone Demineralization, Pathologic; D015519:Bone Density; D005260:Female; D005542:Forearm / Q000503:physiopathology; D006115:Greece; D006801:Humans; D008297:Male; D008875:Middle Aged; D010264:Paraplegia / Q000503:physiopathology* / Q000534:rehabilitation; D010384:Pelvic Bones / Q000503:physiopathology; D013119:Spinal Cord Injuries / Q000503:physiopathology* / Q000534:rehabilitation