Dual-energy X-ray absorptiometry and fracture prediction in patients with spinal cord injuries and disorders

L. Abderhalden, F. M. Weaver, M. Bethel, H. Demirtas, S. Burns, J. Svircev, H. Hoenig, K. Lyles, S. Miskevics, L. D. Carbone

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23 Scopus citations


Summary: Low T-scores at the hip predict incident fractures in persons with a SCI. Introduction: 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. Methods: 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. Results: 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). Conclusion: 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.

Original languageEnglish (US)
Pages (from-to)925-934
Number of pages10
JournalOsteoporosis International
Issue number3
StatePublished - Mar 1 2017


  • Dual-energy X-ray absorptiometry
  • Fractures
  • Osteoporosis
  • Spinal cord injury

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism


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