title: Self-report of one-year fracture incidence and osteoporosis prevalence in a community cohort of canadians with spinal cord injury.
abstract: BACKGROUND
  Sublesional declines in hip and knee region bone mass are a well-established consequence of motor complete spinal cord injury (SCI), placing individuals with SCI at risk for fragility fracture, hospitalization, and fracture-related morbidity and mortality.
  
  
  OBJECTIVE
  To describe the 1-year incidence of fracture and osteoporosis prevalence in a community cohort of Canadians with chronic SCI.
  
  
  METHODS
  As part of the SCI Community Survey, consenting adult participants with chronic SCI completed an online or telephone survey regarding their self-reported medical comorbidities, including fracture and osteoporosis, in the 12 months prior to survey conduct. Survey elements included sociodemographic and impairment descriptors and 4 identified risk factors for lower extremity fragility fracture: injury duration ≥ 10 years, motor complete and sensory complete (AIS A or A-B) paraplegia, and female gender.
  
  
  RESULTS
  Consenting participants included 1,137 adults, 70.9% were male, mean (SD) age was 48.3 (13.3) years, and mean (SD) time post injury was 18.5 (13.1) years. Eighty-four participants (7.4%) reported a fracture in the previous 12 months and 244 (21.5%) reported having osteoporosis in the same time period, with corresponding treatment rates of 84.5% and 64.8%, respectively. The variables most strongly associated with fracture were osteoporosis (odds ratio [OR], 4.3; 95% CI, 2.72-6.89) and having a sensory-complete injury (OR, 2.2; 95% CI, 1.38-3.50) or a motor complete injury (OR, 1.7; 95% CI, 1.10-2.72).
  
  
  CONCLUSIONS
  The discordance between fracture occurrence and treatment and the strength of the association between osteoporosis diagnosis and incident fractures necessitates improved bone health screening and treatment programs, particularly among persons with complete SCI.
authors.affiliation: Toronto Rehabilitation Institute - University Health Network , Toronto, Ontario , Canada ;
authors.forename: Chelsea A
authors.initials: CA
authors.lastname: Pelletier
authors.affiliation: Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS) , Quebec , Canada.
authors.forename: Frédéric S
authors.initials: FS
authors.lastname: Dumont
authors.affiliation: Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS) , Quebec , Canada.
authors.forename: Jean
authors.initials: J
authors.lastname: Leblond
authors.affiliation: Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS) , Quebec , Canada ; Department of Rehabilitation, Université Laval , Quebec City , Canada.
authors.forename: Luc
authors.initials: L
authors.lastname: Noreau
authors.affiliation: Toronto Rehabilitation Institute - University Health Network , Toronto, Ontario , Canada ; ; Department of Kinesiology, University of Waterloo , Ontario , Canada.
authors.forename: Lora
authors.initials: L
authors.lastname: Giangregorio
authors.affiliation: Toronto Rehabilitation Institute - University Health Network , Toronto, Ontario , Canada ; ; Division of Physiatry, Department of Medicine, University of of Toronto , Toronto, Ontario , Canada.
authors.forename: B Catharine
authors.initials: BC
authors.lastname: Craven
keywords: fracture; health services; health surveys; osteoporosis; spinal cord injuries