title: Dual-energy X-ray absorptiometry and fracture prediction in patients with spinal cord injuries and disorders.
abstract: Low T-scores at the hip predict incident fractures in persons with a SCI.
  
  
  
  Persons with a spinal cord injury (SCI) have substantial morbidity and mortality following osteoporotic fractures. The objective of this study was to determine whether dual-energy X-ray absorptiometry (DXA) measurements predict osteoporotic fractures in this population.
  
  
  
  A retrospective historical analysis that includes patients (n = 552) with a SCI of at least 2 years duration who had a DXA performed and were in the VA Spinal Cord Disorders Registry from fiscal year (FY) 2002-2012 was performed.
  
  
  
  The majority of persons (n = 455, 82%) had a diagnosis of osteoporosis or osteopenia, with almost half having osteoporosis. BMD and T-scores at the lumbar spine were not significantly associated with osteoporotic fractures (p > 0.48) for both. In multivariable analyses, osteopenia (OR = 4.75 95% CI 1.23-17.64) or osteoporosis (OR = 4.31, 95% CI 1.15-16.23) compared with normal BMD was significantly associated with fractures and higher T-scores at the hip were inversely associated with fractures (OR 0.73 (95% CI 0.57-0.92)). There was no significant association of T-scores or World Health Organization (WHO) classification with incident fractures in those with complete SCI (p > 0.15 for both).
  
  
  
  The majority (over 80%) of individuals with a SCI have osteopenia or osteoporosis. DXA-derived measurements at the hip, but not the lumbar spine, predict fracture risk in persons with a SCI. WHO-derived bone density categories may be useful in classifying fracture risk in persons with a SCI.
authors.affiliation: Center of Innovation for Complex Chronic Healthcare, Edward J. Hines, Jr. VA Hospital, 5000 S. 5th Ave, P.O. Box 1033, Hines, IL, USA.|Department of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, IL, USA.
authors.forename: L
authors.initials: L
authors.lastname: Abderhalden
authors.affiliation: Center of Innovation for Complex Chronic Healthcare, Edward J. Hines, Jr. VA Hospital, 5000 S. 5th Ave, P.O. Box 1033, Hines, IL, USA.|Public Health Sciences, Stritch School of Medicine, Loyola University, Maywood, IL, USA.
authors.forename: F M
authors.initials: FM
authors.lastname: Weaver
authors.affiliation: Charlie Norwood Veterans Affairs Medical Center, 950 15th St, 6D-155, Augusta, GA, 30912, USA.|Department of Medicine, Medical College of Georgia, Augusta University, Augusta, GA, USA.
authors.forename: M
authors.initials: M
authors.lastname: Bethel
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, IL, USA.
authors.forename: H
authors.initials: H
authors.lastname: Demirtas
authors.affiliation: VA Puget Sound Health Care System-Seattle Division, 1660 S. Columbian Way, Seattle, WA, USA.|Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA.
authors.forename: S
authors.initials: S
authors.lastname: Burns
authors.affiliation: VA Puget Sound Health Care System-Seattle Division, 1660 S. Columbian Way, Seattle, WA, USA.|Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA.
authors.forename: J
authors.initials: J
authors.lastname: Svircev
authors.affiliation: Durham VA Medical Center, 508 Fulton St, Durham, NC, USA.
authors.forename: H
authors.initials: H
authors.lastname: Hoenig
authors.affiliation: Duke University and VA Medical Centers, Durham, NC, USA.|The Carolinas Center for Medical Excellence, Cary, NC, USA.
authors.forename: K
authors.initials: K
authors.lastname: Lyles
authors.affiliation: Public Health Sciences, Stritch School of Medicine, Loyola University, Maywood, IL, USA.
authors.forename: S
authors.initials: S
authors.lastname: Miskevics
authors.affiliation: Charlie Norwood Veterans Affairs Medical Center, 950 15th St, 6D-155, Augusta, GA, 30912, USA. lcarbone@gru.edu.|Department of Medicine, Medical College of Georgia, Augusta University, Augusta, GA, USA. lcarbone@gru.edu.
authors.forename: L D
authors.initials: LD
authors.lastname: Carbone
mesh_terms: D015502:Absorptiometry, Photon; D000328:Adult; D000368:Aged; D015519:Bone Density / Q000502:physiology; D005260:Female; D006621:Hip Joint / Q000503:physiopathology; D006801:Humans; D008159:Lumbar Vertebrae / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology; D058866:Osteoporotic Fractures / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D011237:Predictive Value of Tests; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods; D013119:Spinal Cord Injuries / Q000150:complications* / Q000453:epidemiology / Q000503:physiopathology; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs
keywords: Dual-energy X-ray absorptiometry; Fractures; Osteoporosis; Spinal cord injury