Diagnostic and therapeutic perspectives in osteoporosis after spinal cord injury
DOI:
https://doi.org/10.11606/issn.2317-0190.v11i1a102471Keywords:
Spinal Cord Injuries, Osteoporosis, Bone Density, Paraplegia, QuadriplegiaAbstract
Osteoporosis is a well-known complication of spinal cord injury, but many challenges remain as for integral pathophysiology and optimum management. Good part of bone loss occurs during the acute phase and stabilises around twelve to sixteen months later. Bone loss affects the whole body but is more profound in paralysed areas, being more intense in areas that are rich in trabecular bone. Mechanisms involved are not totally understood but include not only loss of normal biomechanical stress but also neurovascular and collagen structural changes. Both biochemical markers and histomorphometric analysis show increase of bone reabsorption, with insufficient bone formation. Densitometric studies show mineral bone dissociation between the lumbar column and the hip, with greater loss at the hip and major loss in lower extremities, typical of this group of patients. As a result, the greater incidence of fractures that is estimated to be between 1 to 7%, and frequently a result of minor trauma. Therapies involving orthostatism and exercises failed to show benefit in reducing bone loss and studies with functional electric stimulation have contradictory results and there seems to be some local benefit. The use of anti-reabsorptive drugs seem to be an option, sthe acute phase, but more studies are necessary to evaluate the effectiveness of this intervention, the decrease of the incidence of fractures.
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