FRACTURE RATES AND RISK-FACTORS FOR FRACTURES IN PATIENTS WITH SPINAL-CORD INJURY

Aim: To study fracture rates and risk factors for fractures in patient s with spinal cord injuries. Material and methods: A self-administered questionnaire was mailed to 646 members of the Danish Paraplegic Asso ciation and 1000 randomly selected normal controls. 438 patients (309 males, 129 females, 67.8%) and 654 controls (332 males, 322 females, 6 5.4%) returned the questionnaire. Median age in patients was 42, range 10-80 years, and in controls 43, range 19-93 years (2p = 0.25). Resul ts: The crude fracture rate was 2% per year in patients and 1% per yea r in controls (RR = 2.0, P < 0.001), Low-energy fractures were much mo re prominent in patients (19.0% of all fractures) than in controls (1. 4% , P < 0.001). The fracture rate did not differ before the injury bu t increased after the injury to a constant level from the third year a nd forward. Fractures of the lower extremities were more prominent in patients than controls (femurs: RR = 23.4, P < 0.001, lower legs: RR = 5.2, P < 0.001, feet/toes: RR = 2.4, P = 0.006) while fractures of th e forearms (P < 0.001) and clavicles (P = 0.03) were absent among pati ents. Fractures were more frequent in female patients (RR = 1.6, P = 0 .008) and in male patients with a family history of fractures (RR = 2. 0, P = 0.004). Conclusions: Low-energy fractures especially of the low er extremities are frequent in spinal cord injury patients and especia lly among female patients. The forearms seem protected from fractures.