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Osteoporotic fractures and hospitalization risk in chronic spinal cord injury

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Abstract

Summary

Osteoporosis is a well acknowledged complication of spinal cord injury. We report that motor complete spinal cord injury and post-injury alcohol consumption are risk factors for hospitalization for fracture treatment. The clinical assessment did not include osteoporosis diagnosis and treatment considerations, indicating a need for improved clinical protocols.

Introduction

Treatment of osteoporotic long bone fractures often results in lengthy hospitalizations for individuals with spinal cord injury. Clinical features and factors that contribute to hospitalization risk have not previously been described.

Methods

Three hundred and fifteen veterans ≥ 1 year after spinal cord injury completed a health questionnaire and underwent clinical exam at study entry. Multivariate Cox regression accounting for repeated events was used to assess longitudinal predictors of fracture-related hospitalizations in Veterans Affairs Medical Centers 1996–2003.

Results

One thousand four hundred and eighty-seven hospital admissions occurred among 315 participants, and 39 hospitalizations (2.6%) were for fracture treatment. Median length of stay was 35 days. Fracture-related complications occurred in 53%. Independent risk factors for admission were motor complete versus motor incomplete spinal cord injury (hazard ratio = 3.73, 95% CI = 1.46–10.50). There was a significant linear trend in risk with greater alcohol consumption after injury. Record review indicated that evaluation for osteoporosis was not obtained during these admissions.

Conclusions

Assessed prospectively, hospitalization in Veterans Affairs Medical Centers for low-impact fractures is more common in motor complete spinal cord injury and is associated with greater alcohol use after injury. Osteoporosis diagnosis and treatment considerations were not part of a clinical assessment, indicating the need for improved protocols that might prevent low-impact fractures and related admissions.

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Acknowledgments

We wish to acknowledge Joda Alian for her kind assistance in manuscript editing and preparation.

Conflicts of interest

None.

Disclaimers

The project reported/outlined here was supported by the Office of Research and Development, Health Services R&D Service, Quality Enhancement Research Initiative RRP-07–312 and NIH/NICHD RO1 HD42141 (Dr. Garshick). Dr. Garshick is the Associate Chief of Pulmonary and Critical Care Medicine at VA Boston Healthcare System. The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs.

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Authors and Affiliations

  1. Department of Physical Medicine and Rehabilitation, Harvard Medical School and Spaulding Rehabilitation Hospital, Boston, MA, USA

    L. R. Morse

  2. Department of Cytokine Biology, Forsyth Institute, Boston, MA, USA

    R. A. Battaglino

  3. Research and Development Service, Department of Veterans Affairs, VA Boston Healthcare System, Boston, MA, USA

    K. L. Stolzmann, L. D. Hallett, A. Waddimba, D. Gagnon, A. A. Lazzari & E. Garshick

  4. Programs in Research at VA Boston, Harvard Medical School, Boston, MA, USA

    K. L. Stolzmann, L. D. Hallett, A. Waddimba & E. Garshick

  5. VA Cooperative Studies Program, VA Boston Healthcare System, Department of Biostatistics, Boston University School of Public Health, Boston, USA

    D. Gagnon

  6. Department of Health Policy and Management, School of Public Health, Boston, MA, USA

    A. Waddimba

  7. Division of Primary Care, Rheumatology Section, Osteoporosis Prevention Clinic, Boston Division, VA Boston Healthcare System, Boston, MA, USA

    A. A. Lazzari

  8. Boston University School of Medicine, Boston, MA, USA

    A. A. Lazzari

  9. Pulmonary and Critical Care Medicine Section, Medical Service, VA Boston Healthcare System, Boston, MA, USA

    E. Garshick

  10. Channing Laboratory, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    A. Waddimba & E. Garshick

  11. Department of PMR, Harvard Medical School, The Forsyth Institute, 140 The Fenway, Boston, MA, 02118, USA

    L. R. Morse

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  1. L. R. Morse
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  2. R. A. Battaglino
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  3. K. L. Stolzmann
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  6. D. Gagnon
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Correspondence to L. R. Morse.

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Morse, L.R., Battaglino, R.A., Stolzmann, K.L. et al. Osteoporotic fractures and hospitalization risk in chronic spinal cord injury. Osteoporos Int 20, 385–392 (2009). https://doi.org/10.1007/s00198-008-0671-6

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  • DOI: https://doi.org/10.1007/s00198-008-0671-6

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