Asymmetric lower-limb bone loss after spinal cord injury: Case report

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Asymmetric lower-limb bone loss after spinal cord
injury Case report

• Alison M. Lichy, PT, DPT, NCS Suzanne Groah,
  MD, MPH

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• Aim
• Describe case of ambulatory male with motor
  incomplete spinal cord injury (SCI) and
  asymmetric lower-limb osteoporosis.
• Determine relationships among bone mineral
  density (BMD), motor function, and gait pattern.
• Relevance
• Osteoporosis occurs rapidly after acute SCI, with
  nearly 1/3 of bone loss occurring within 4 months
  after injury and continuing over next several
  years.

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Methods

• 32 yr old Caucasian male injured in work-related
  fall
• Initial T4 American Spinal Injury Association
  Impairment Scale (AIS) A.
• 3 mo robotic body-weight-supported treadmill
  training 3 times/wk.
• Outcome measures at 11 wk (baseline), 5 mo, and
  1.5 yr postinjury
• AIS examination.
• Walking Index for Spinal Cord Injury Version 2
  (WISCI-II).
• BMD via dual-energy X-ray absorptiometry (DXA).
• Weight-bearing analysis (1.5 yr follow-up only).

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Results

• AIS motor scores
• No change on right
• Hip flexion strength of left improved.
• BMD decreased
• Lumbar spine
• 2.77 loss
• Right proximal femur
• 3.96 loss
• Left proximal femur
• 10.52 loss

• WISCI-II scores increased
• Baseline 6
• Ambulating with rolling-walker, left orthosis,
  and 1-person assistance.
• 5 mo 10
• Ambulating with rolling-walker.
• 1.5 yr 19
• Ambulating independently with single-point cane.

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Results
At 1.5 yr postinjury, additional DXA measurements
at distal femur and proximal tibia revealed
higher BMD in patients right vs left lower limb.
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Conclusions

• Patient's asymmetric lower-limb motor function
  and gait pattern may have combined to result in
  asymmetric BMD loss.
• This case demonstrates need for BMD monitoring
  even in ambulatory individuals with SCI
• May benefit from treatment to reduce BMD loss and
  avoid fractures.