Archives of Physical Medicine and Rehabilitation
Volume 89, Issue 2 , Pages 237-243 , February 2008

Incidence of Fractures in a Cohort of Veterans With Chronic Multiple Sclerosis or Traumatic Spinal Cord Injury

Presented to the American Spinal Association, September 2006, Las Vegas, NV, and the American Geriatrics Association, May 2006, Chicago, IL.

  • William C. Logan Jr, MD

      Affiliations

    • Division of Geriatrics, Department of Medicine, Duke University Medical Center, Durham, NC
    • Geriatric Research Education and Clinical Center, Durham VA Medical Center, Durham, NC
    • Division of Geriatrics, Greenville Hospital System/University Medical Center, Greenville, SC
    • Corresponding Author InformationReprint requests to William C. Logan, Jr, MD, Division of Geriatrics, Greenville Hospital System/University Medical Center, Center for Success in Aging, 255 Enterprise Blvd., Suite 101, Greenville, SC 29615
    • ,
  • Richard Sloane, MS

      Affiliations

    • Center for the Study of Aging and Human Development, Duke University, Durham, NC
    • ,
  • Kenneth W. Lyles, MD

      Affiliations

    • Endocrinology and Geriatrics, Duke University Medical Center, Durham, NC
    • ,
  • Barry Goldstein, MD, PhD

      Affiliations

    • Spinal Cord Injury and Disorders Strategic Healthcare Group, Department of Veterans Affairs, Puget Sound Health Care System, Seattle, WA
    • ,
  • Helen M. Hoenig, MD, MPH

      Affiliations

    • Duke University Medical Center, Durham, NC
    • Physical Medicine and Rehabilitation, Durham VA Medical Center, Durham, NC.

References 

  1. McKinley WO, Jackson AB, Cardenas DD, DeVivo MJ. Long-term medical complications after traumatic spinal cord injury: a regional model systems analysis. Arch Phys Med Rehabil. 1999;80:1402–1410
  2. Comarr AE, Hutchinson RH, Bors E. Extremity fractures of patients with spinal cord injuries. Am J Surg. 1962;103:732–739
  3. Garland DE, Rhoades ME. Orthopedic management of brain-injured adults (Part II). Clin Orthop Relat Res. 1978;(131):111–122Mar
  4. Ragnarsson KT, Sell GH. Lower extremity fractures after spinal cord injury: a retrospective study. Arch Phys Med Rehabil. 1981;62:418–423
  5. Freehafer AA, Hazel CM, Becker CL. Lower extremity fractures in patients with spinal cord injury. Paraplegia. 1981;19:367–372
  6. Ingram RR, Suman RK, Freeman PA. Lower limb fractures in the chronic spinal cord injured patient. Paraplegia. 1989;27:133–139
  7. Keating JF, Kerr M, Delargy M. Minimal trauma causing fractures in patients with spinal cord injury. Disabil Rehabil. 1992;14:108–109
  8. Albright F, Burnett CH, Cope O, Parson W. Acute atrophy of bone (osteoporosis) simulating hyperparathyroidism. J Clin Endocrinol. 1941;1:711–716
  9. BeDell KK, Scremin AM, Perell KL, Kunkel CF. Effects of functional electrical stimulation-induced lower extremity cycling on bone density of spinal cord-injured patients. Am J Phys Med Rehabil. 1996;75:29–34
  10. Uebelhart D, Demiaux-Domenech B, Roth M, Chantraine A. Bone metabolism in spinal cord injured individuals and in others who have prolonged immobilisation (A review). Paraplegia. 1995;33:669–673
  11. Szollar SM, Martin EM, Sartoris DJ, Parthemore JG, Deftos LJ. Bone mineral density and indexes of bone metabolism in spinal cord injury. Am J Phys Med Rehabil. 1998;77:28–35
  12. Dauty M, Perrouin VB, Maugars Y, Dubois C, Mathe JF. Supralesional and sublesional bone mineral density in spinal cord-injured patients. Bone. 2000;27:305–309
  13. Zehnder Y, Luthi M, Michel D, et al. Long-term changes in bone metabolism, bone mineral density, quantitative ultrasound parameters, and fracture incidence after spinal cord injury: a cross-sectional observational study in 100 paraplegic men. Osteoporos Int. 2004;15:180–189
  14. Frisbie JH. Fractures after myelopathy: the risk quantified. J Spinal Cord Med. 1997;20:66–69
  15. Nottage WM. A review of long-bone fractures in patients with spinal cord injuries. Clin Orthop Relat Res. 1981;(155):65–70Mar
  16. Lazo MG, Shirazi P, Sam M, Giobbie-Hurder A, Blacconiere MJ, Muppidi M. Osteoporosis and risk of fracture in men with spinal cord injury. Spinal Cord. 2001;39:208–214
  17. Vestergaard P, Krogh K, Rejnmark L, Mosekilde L. Fracture rates and risk factors for fractures in patients with spinal cord injury. Spinal Cord. 1998;36:790–796
  18. Garland DE, Stewart CA, Adkins RH, et al. Osteoporosis after spinal cord injury. J Orthop Res. 1992;10:371–378
  19. Cocksedge S, Freestone S, Martin JF. Unrecognised femoral fractures in patients with paraplegia due to multiple sclerosis. Br Med J (Clin Res Ed). 1984;289(6440):309
  20. Williams P, Frank A, Crawford CM, Alcorn T. Unrecognised femoral fractures in patients with paraplegia due to multiple sclerosis. Br Med J (Clin Res Ed). 1984;289(6443):501
  21. Kiessling WR, Maske B. [The problem of femoral neck fracture in multiple sclerosis]. [German] Fortschr Neurol Psychiatr. 1989;57(3):107–109
  22. Stenager E, Jensen K. Fractures in multiple sclerosis. Acta Neurol Belg. 1991;91:296–302
  23. Cosman F, Nieves J, Komar L, et al. Fracture history and bone loss in patients with MS. Neurology. 1998;51:1161–1165
  24. Garland DE, Adkins RH, Stewart CA. The natural history of bone loss in the lower extremity of complete spinal cord-injured males. Top Spinal Cord Inj Rehabil. 2005;11:48–60
  25. Wang CM, Chen Y, DeVivo MJ, Huang CT. Epidemiology of extraspinal fractures 22 associated with acute spinal cord injury. Spinal Cord. 2001;39:589–594
  26. Samsa G, Hoenig H, Carswell J, et al. Developing a national registry of veterans with spinal cord dysfunction: experiences and implications. Spinal Cord. 1998;36:57–62
  27. Hoenig H, McIntyre L, Hoff J, Samsa G, Branch LG. Disability fingerprints: patterns of 27 in spinal cord injury and multiple sclerosis differ. J Gerontol A Biol Sci Med Sci. 1999;54:M613–M620
  28. Hoenig H, Hoff J, McIntyre L, Branch LG. The self-reported functional measure: predictive validity for health care utilization in multiple sclerosis and spinal cord injury. Arch Phys Med Rehabil. 2001;82:613–618
  29. ICD-9-CM expert for hospitals: International Classification of Diseases 9th Revision Clinical Modification. 6th ed.. Salt Lake City: Ingenix; 2005;
  30. CPT 2005: Current procedural terminology. Chicago: AMA Pr; 2004;
  31. Hoenig H, Branch LG, McIntyre L, Hoff J, Horner RD. The validity in persons with spinal cord injury of a self-reported functional measure derived from the functional independence measure. Spine. 1999;24:539–543
  32. Whitson HE, Pieper CF, Sanders L, Horner RD, Duncan PW, Lyles KW. Adding injury to insult: fracture risk after stroke in veterans. J Am Geriatr Soc. 2006;54:1082–1088
  33. Maimoun L, Fattal C, Micallef JP, Peruchon E, Rabischong P. Bone loss in spinal cord-injured patients: from physiopathology to therapy. Spinal Cord. 2005;44:203–210
  34. Maimoun L, Couret I, Mariano-Goulart D, et al. Changes in osteoprotegerin/RANKL system, bone mineral density, and bone biochemicals markers in patients with recent spinal cord injury. Calcif Tissue Int. 2005;76:404–411
  35. Kurtzke JF. Patterns of neurologic involvement in multiple sclerosis. Neurology. 1989;39:1235–1238
  36. Jiang SD, Dai LY, Jiang LS. Osteoporosis after spinal cord injury. Osteoporos Int. 2006;17:180–192
  37. Roth MP, Clayton J, Patois E, Alperovitch A. Gender distributions in parents and children concordant for multiple sclerosis. Neuroepidemiology. 1994;13:211–215
  38. Kanis JA, Johansson H, Oden A, et al. A meta-analysis of prior corticosteroid use and fracture risk. J Bone Miner Res. 2004;19:893–899
  39. Troiano RA, Jotkowitz A, Cook SD, Bansil S, Zito G. Rate and types of fractures in corticosteroid-treated multiple sclerosis patients. Neurology. 1992;42:1389–1391
  40. Barrett-Connor E, Siris ES, Wehren LE, et al. Osteoporosis and fracture risk in women of different ethnic groups. J Bone Miner Res. 2005;20:185–194

 Supported by the Center For the Study of Aging and Human Development.A commercial party having a direct financial interest in the results of the research supporting this article has conferred or will confer a financial benefit upon the author or one or more of the authors. Lyles has received financial support from Novartis, the Alliance for Better Bone Health, and Amgen; he is a consultant to Novartis, Procter & Gamble, Merck, Amgen, GTx, and Bone Medical Ltd; he holds U.S. patent 20050272707 (methods for preventing or reducing secondary fractures after hip fracture); and has a provisional patent application (medications kits and formulations for preventing, treating, or reducing secondary fractures after previous fracture).

PII: S0003-9993(07)01654-1

doi: 10.1016/j.apmr.2007.08.144

Archives of Physical Medicine and Rehabilitation
Volume 89, Issue 2 , Pages 237-243 , February 2008

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