Pharmacologic and Nonpharmacologic Treatment Modalities for Bone Loss in SCI - Proposal for Combined Approach

Individuals with a spinal cord injury (SCI) often experience osteoporosis, a well-recognized high-acuity complication given the associated sequelae. Osteoporosis may develop with loss of one-third of the bone mineral density (BMD) below the level of injury within one year of the incident SCI.1 As a result, approximately 5-34% of individuals with SCI sustain fractures at one year post injury with 70% experiencing a low-impact fractures during their lifetime.2, 3 While most osteoporotic fractures are treated nonoperatively, several complications may occur: reduced quality of life, reduced range motion, skin pressure ulcers, and amputation.1,4 As such, mitigating osteoporotic bone loss is paramount for individuals with SCI.

Historically, pharmaceutical options for osteoporosis have been the primary therapy due to immobilization of the paralyzed extremities in SCI and the associated challenges of engaging in dynamic weight-bearing activities.5 As of late, novel rehabilitation interventions are being tested to prevent or treat BMD loss. In particular, functional electrical stimulation (FES) allows for external activation of musculature below the injury level to promote exercises targeting the paralyzed lower limbs. FES in both SCI and non-SCI populations has been shown to both maintain and increase BMD.6, 7, 8 Unfortunately, these treatments are still in their infancy. Thus, the purpose of this review is to summarize the current evidence for therapeutic interventions, including pharmacologic and nonpharmacologic avenues, for osteoporosis in individuals with SCI.

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