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L - Skeletal Integrity

Skeletal Integrity | Body Structure and Function C Craven, MD; L Blencowe, MSc; AS Burns, MD; I Côté, MD; LM Giangregorio, PhD; and the E-Scan Investigative Team Skeletal Integrity refers to whether an individual with spinal cord injury (SCI) has adequate bone architecture and alignment to allow for participation in his or her choice of rehabilitation interventions and leisure pursuits. Sublesional Osteoporosis (SLOP) is a disease process unique to individuals with SCI, characterized by excess bone resorption and deterioration in lower extremity bone density and bone architecture, which leads to a lifetime of increased risk of lower extremity fragility fracture (see Table 1.0). Common problems following SCI that influence skeletal integrity include SLOP and related fragility fractures, heterotopic ossification, scoliosis, kyphosis and Charcot joints. This chapter discusses the prevention, detection and treatment of SLOP and fracture management, among individuals with SCI. Photo courtesy of Rich Vanderwal Table 1.0 DEFINITION OF SUBLESIONAL OSTEOPOROSIS (SLOP). Among individuals with motor complete SCI, there is a characteristic 3%-4% per month decline in hip and knee region bone mineral density (BMD), in the first year after injury. Typically, BMD of the hips, thigh bone (distal femur), and shin bone (proximal tibia) are 28%, 37% to 43%, and 36% to 50% below that of gender-matched peers, at 12 to 18 months post injury. There is disagreement whether this decline in BMD continues with chronic injury, or stabilizes after the initial injury. The result of these processes is a lifetime-increased risk of lower extremity fragility fracture. A fragility fracture is one that results from mechanical forces which would not ordinarily cause fracture in a healthy young adult (see Figure 1.0). Distal femur and proximal tibia fragility fractures prevail in the SCI patient population, with 25% to 46% of chronic SCI patients developing fragility fractures. Torsional stresses on the legs, during a transfer, or compressive forces at the knee, during a low velocity fall, are frequent causes of distal femur and proximal tibia fractures. Figure 1.0 Most comon sites of fracture after SCI in descending order of frequency, and comon fracture risk factors , after SCI. Age Range Definition Men ≥ 60 years or postmenopausal women Hip or knee region T score ≤ -2.5 Men < 59 years or premenopausal women Hip or knee region Z score < -2.0 with ≥ 3 risk factors for fracture Men or women age 16–90 Prior fragility fracture and no identifiable etiology of osteoporosis, other than SCI T score is the number of standard deviations (SD) BMD above or below gender-specific young adult mean peak bone mass. Z score is the number of SD BMD above or below that, expected for individuals of the same age and gender. Reproduced from Craven BC, Robertson LA, McGillivray CF, Adachi JD (page 9).1 © 2009 Thomas Land Publishers, Inc. www.thomasland.com. Reprinted with permission. Yes FRACTURE RISK FACTORS CHECKLIST Age at injury < 16 years2 Alcohol intake > 5 servings/day3 BMI < 194 Duration of SCI ≥ 10 years5 Female5,6 Motor complete (AIS A-B)7 Paraplegia8 Prior fragility fracture Family history of fracture9 3 2 1 Reproduced from Craven BC, Robertson LA, McGillivray CF, Adachi JD (page 6).1 Copyright 2009 Thomas Land Publishers, Inc. www.thomasland.com. Reprinted with permission. SKELETAL INTEGRITY | BODY STRUCTURE AND FNUCTION 115


L - Skeletal Integrity
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