Osteoporosis Following a Spinal Cord Lesion: Case Report

Abstract

Spinal cord injury (SCI) is a cause of secondary osteoporosis. The loss of bone mass after a SCI happens throughout the skeleton with greater affection of inferior extremities. This loss of bone is quicker in the first 4 months following a SCI. It continues, however to a lesser degree, over the years. A 56-year-old male patient suffered an automobile accident in 1986 with a concomitant fracture-luxation of C5-C6 vertebrae from which resulted a SCI – classified as a Tetraplegia B in the! American Spinal Cord Injury Association!(ASIA) Scale, with C4 as the neurological level. The patient was admitted to an inpatient Rehabilitation Centre on May 11, 2020, for a comprehensive and multiprofessional rehabilitation. On June 22, 2020, the patient presented with a left thigh crepitation after had been heard a “pop” during passive mobilization of the hip. The Rehabilitation Specialist asked for a radiography. The patient was transferred to an Emergency Department, being diagnosed a spiral diaphyseal fracture of the left femur – a fragility fracture due to sublesional osteoporosis. On June 29, the patient was submitted to an open reduction and internal fixation with an antegrade long nail. The patient returned to the Rehabilitation Centre on July 7 where 70 mg of oral alendronate weekly was introduced. On August 5, control radiographs showed no signs of bone consolidation. Until today, there are no guidelines to treat osteoporosis after a SCI. There are studies in the acute phase of the SCI but there is a lack of evidence when it evolves to chronicity. Bisphosphonates are a class of anti-osteoclast-mediated bone loss osteoporosis who have presented good results!on the BMD, especially oral alendronate, but none demonstrated a diminishing of the fracture risk.