Osteoporosis in Veterans with Spinal Cord Injury: an Overview of Pathophysiology, Diagnosis, and Treatments

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3 Scopus citations


Immediately after spinal cord injury (SCI), approximately 75% of patients suffer rapid and severe loss of bone mineral density (BMD) below the lesion level (i.e., sublesional), leading to osteoporosis (OP) in ~ 60% 1-year post-injury. The distal femur (DF) and proximal tibia (PT) are most commonly involved, and 70% of SCI patients sustain a low impact fracture at some point in their lifetime, adding disability to an already physically challenged population. Unfortunately, OP treatments for post-menopausal women are not as effective for OP post-SCI. Mechanisms of new agents targeting the neurogenic etiology of bone resorption (i.e., denosumab and anti-sclerostin antibodies) may hold greater potential and are discussed. Furthermore, standardized DXA protocols with normative BMD values for the DF and PT sites have not been established, so diagnosing OP is problematic. This review will summarize the pathophysiology of sublesional OP after SCI, the unique challenges of diagnosing and managing OP in SCI patients and provide recommendations for future studies. Given the Veterans Health Administration (VA) is the largest health care system in the world for persons with SCI, it is well-equipped to add to gaps in the literature.

Original languageEnglish (US)
Pages (from-to)94-108
Number of pages15
JournalClinical Reviews in Bone and Mineral Metabolism
Issue number2
StatePublished - Jun 15 2019


  • Bone mineral density
  • Dual energy x-ray absorptiometry
  • Fractures
  • Neurogenic osteoporosis
  • Spinal cord injury

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Orthopedics and Sports Medicine
  • Endocrinology


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