Fractures after myelopathy: the risk quantified

Area of Science:

• Orthopedics
• Neurology
• Geriatrics

Background:

• Lower extremity fractures are known complications of paralysis from spinal cord injury (SCI).
• The precise risk quantification and the influence of aging on fracture incidence in SCI patients remain underexplored.
• Age is a known factor predisposing individuals to osteoporosis, potentially exacerbating fracture risk in SCI.

Purpose of the Study:

• To quantify the long-term risk of fractures in male patients with SCI.
• To investigate the relationship between age and fracture incidence in this population.
• To compare fracture rates in SCI patients to the general male population.

Main Methods:

• A long-term follow-up review of 120 male SCI patients (91% traumatic SCI).
• Data collected on fracture events, locations, and patient demographics, including age.
• Incidence rates calculated per 1000 patient-years and compared across age intervals.

Main Results:

• 33% of patients experienced 76 fracture events, resulting in 103 fractures, with 82% in lower extremity long bones.
• Fracture incidence increased significantly with age: 14.5, 31.1, and 45.7 events per 1000 patient-years for age groups 20-39, 40-59, and 60-79, respectively.
• Femoral (including hip) fracture rates in SCI patients were substantially higher than in the general male population (104x at age 50, 24x at age 70).

Conclusions:

• Myelopathy due to SCI markedly increases the risk of lower extremity long bone fractures in men.
• The risk of these fractures is further amplified by advancing age.
• These findings underscore the importance of age-specific fracture risk assessment and management in SCI patients.