A primary care provider's guide to bone health in spinal cord-related paralysis

Cristina L. Sadowsky, Nina Mingioni, Joseph Zinski

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Individuals with spinal cord injury/disorder (SCI/D) are at high risk for developing secondary osteoporosis. Bone loss after neurologic injury is multifactorial and is dependent on the time from and extent of neurologic injury. Most bone loss occurs in the first year after complete motor paralysis, and fractures occur most commonly in the distal femur and proximal tibia (paraplegic fracture). The 2019 International Society for Clinical Densitometry Position Statement in SCI establishes that dual-energy X-ray absorptiometry (DXA) can be used to both diagnose osteoporosis and predict lower extremity fracture risk in individuals with SCI/D. Pharmacologic treatments used in primary osteoporosis have mixed results when used for SCI/D-related osteoporosis. Ambulation, standing, and electrical stimulation may be helpful at increasing bone mineral density (BMD) in individuals with SCI/D but do not necessarily correlate with fracture risk reduction. Clinicians caring for individuals with spinal cord–related paralysis must maintain a high index of suspicion for fragility fractures and consider referral for surgical evaluation and management.

Original languageEnglish (US)
Pages (from-to)128-132
Number of pages5
JournalTopics in Spinal Cord Injury Rehabilitation
Issue number2
StatePublished - 2020


  • Low bone mass
  • Osteoporosis
  • Secondary osteoporosis
  • Spinal cord injury/disease (SCI/D)

ASJC Scopus subject areas

  • Physical Therapy, Sports Therapy and Rehabilitation
  • Rehabilitation
  • Clinical Neurology


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