The mechanical consequence of actual bone loss and simulated bone recovery in acute spinal cord injury

- Changes to bone mineral and strength were assessed after spinal cord injury (SCI).
- 4 months of acute SCI was associated with an 8% reduction in proximal tibia volumetric BMD.
- Reductions in strength were twofold greater than reductions in volumetric BMD.
- Simulating bone mineral recovery did not necessarily restore strength to baseline levels.

IntroductionSpinal cord injury (SCI) is characterized by rapid bone loss and an increased risk of fragility fracture around regions of the knee. Our purpose was to quantify changes in torsional stiffness K and strength Tult at the proximal tibia due to actual bone loss and simulated bone recovery in acute SCI.MethodsComputed tomography scans were acquired on ten subjects with acute SCI at serial time points separated by a mean of 3.9 months (range 3.0 to 4.8 months). Reductions in bone mineral were quantified and a validated subject-specific finite element modeling procedure was used to predict changes in K and Tult. The modeling procedure was subsequently used to examine the effect of simulated hypothetical treatments, in which bone mineral of the proximal tibiae were restored to baseline levels, while all other parameters were held constant.ResultsDuring the acute period of SCI, subjects lost 8.3 ± 4.9% (p < 0.001) of their bone mineral density (BMD). Reductions in K (− 9.9 ± 6.5%; p = 0.002) were similar in magnitude to reductions in BMD, however reductions in Tult (− 15.8 ± 13.8%; p = 0.005) were some 2 times greater than the reductions in BMD. Owing to structural changes in geometry and mineral distribution, Tult was not necessarily recovered when bone mineral was restored to baseline, but was dependent upon the degree of bone loss prior to hypothetical treatments (r ≥ 0.719; p ≤ 0.019).ConclusionsTherapeutic interventions to halt or attenuate bone loss associated with SCI should be implemented soon after injury in an attempt to preserve mechanical integrity and prevent fracture.