Circulating sclerostin is elevated in short-term and reduced in long-term SCI

► We analyzed sclerostin in 155 men with SCI who were 1 year or more after injury. ► Sclerostin levels are initially increased in SCI due to mechanical unloading. ► In long term SCI sclerostin levels are reduced due to severe osteoporosis. ► Sclerostin may have dual roles after SCI: therapeutic target and bone biomarker.