Because of legal restrictions, MOMSCIS cannot give specific medical advice. The following information is not a substitute for the personal care or advice of your physician. Please discuss any concerns with your physician regarding your medical care. Physicians in the Physical Medicine & Rehabilitation Department at the University of Missouri-Columbia are available to evaluate patient records, and can set up a clinic visit for a medical evaluation. The PM&R Department does extensive treatment of individuals with spinal cord injuries using a wide variety of physical therapies and state-of-the-art medications. Individuals with spinal cord injuries can be examined and treated on an outpatient or inpatient basis. For more information about the PM&R services available or to schedule a clinic visit, telephone the clinic at (573) 884-0033.

Osteoporosis is a common condition

By Michael Acuff, M.D.
MOMSCIS Spinal Cord Injury Specialist

Q: My son is a C5/C6 quadriplegic. He is now 24 and was told recently that he has osteoporosis in his hip. Do you recommend calcium supplements, weight bearing, calcitonin, etc.? Our local rehab does not suggest doing anything, which upsets us because if there ever is a cure, people like my son will have such poor bone health they will never be able to walk.

A: Osteoporosis after spinal cord injury is a common condition that occurs in virtually every individual who has lost movement and the ability to stand on their lower extremities.

Some principles that relate to good bone health can be followed as well as some medical treatments to help prevent bone loss or enhance bone strengthening can be given. First of all, to avoid increasing bone loss, it is advised that cigarette smoking be avoided completely. It is also advised that alcohol be avoided as well. Some reports have shown that individuals who drink a lot of carbonated beverages and soda pop have increased bone loss, therefore, I recommend that a person would limit their carbonated beverage intake to one can of soda a day.

Other factors that can increase bone loss include decreased physical activity, decreased exercise and decreased weightbearing. These factors may be unavoidable for individuals after spinal cord injury.

It has also been shown that after spinal cord injury, there are some endocrine changes that occur that may enhance bone loss as well. For men, this would be a decrease in the hormone testosterone and for women, it might be associated with the decrease in the hormone estrogen. Because of this, I recommend that individuals with spinal cord injury be screened for hormone deficiency and receive hormone replacement therapy if there are signs of low hormone levels. This hormone replacement can help prevent bone loss and improve bone strength.

If possible, weightbearing with a standing frame or some sort of brace would be advisable to maintain good bone health. Exercise in the realm of range of motion or as extensive as electrical stimulation can be helpful in improving the potential for good bone strength.

I do recommend that individuals take a calcium supplement. The calcium supplement should also contain vitamin D, which allows for the calcium to be absorbed and metabolized appropriately to be used by the bones. There are medications that can be given in an attempt to improve bone density. An individual must be evaluated by their physician to see if they are a candidate for these medications and would likely require a screening bone scan to assess the extent of their osteoporosis prior to starting any of these medications.

With all of these treatment possibilities, there is still no good answer for preventing or reversing osteoporosis for individuals with spinal cord injury. I do feel if all of these treatment approaches are considered and undertaken, if appropriate, that an individual can maintain the best possible bone health for their individual condition.