Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Fall;29(Suppl):112-113.
doi: 10.46292/sci23-00063S. Epub 2023 Nov 17.

Using Risk Scores to Estimate Lower Extremity Fragility Fracture Risk among Individuals with Chronic Spinal Cord Injury: A Preliminary Model

B Catharine Craven  1   2   3   4   5 , Lora M Giangregorio  1   3 , Isabelle Côté  6 , Lindsie Blencowe  1 , Masae Miyatani  1 , Mohammad Alavinia  1
Affiliations

Using Risk Scores to Estimate Lower Extremity Fragility Fracture Risk among Individuals with Chronic Spinal Cord Injury: A Preliminary Model

B Catharine Craven et al. Top Spinal Cord Inj Rehabil. 2023 Fall.

Abstract

Objectives: To develop SCI-FX, a risk score to estimate 5-year lower extremity fragility fracture risk among patients living with chronic spinal cord injury (cSCI).

Methods: Adults with traumatic cSCI (n = 90) participated in a 2-year prospective longitudinal cohort study describing bone mineral density (BMD) change and fracture incidence conducted at the Lyndhurst Centre (University Health Network), University of Waterloo, and Physical Disability Rehabilitation Institute of Québec City. Prior publication and clinical intuition were used to identify fragility fracture risk factors including prior fragility fracture, years post-injury, motor complete injury (AIS A/B), benzodiazepine use, opioid use, and parental osteoporosis. We conducted bivariate analyses to identify variables associated with fracture. Multiple logistic regressions were performed using fragility fracture incidence as the dependent variable and all variables from the univariate analyses with a highly liberal p value at 0.2. Using the odds ratios (ORs) from the multiple logistic regression model, a point system for fragility fracture risk score was developed, and the odds of fracture for each point was estimated.

Results: All initial variables, with the exception of benzodiazepine exposure, were included in the final model.

Conclusion: We identified a simple preliminary model for clinicians to estimate 5-year fracture risk among patients with cSCI based on their total score.

Keywords: fracture; osteoporosis; risk score; spinal cord injuries.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest Dr. Craven reports grants from the Canadian Institutes of Health Research (CIHR), Ontario Ministry of Health, Paralyzed Veterans of America, Craig H. Nielsen Foundation, and Praxis Spinal Cord Institute during the conduct of the study. Dr. Craven acknowledges funding from the Toronto Rehabilitation Institute and UHNRMA AFP Innovation funds. She acknowledges support from the UHN foundation at the University of Toronto/Toronto Rehabilitation Institute Chair in Spinal Cord Injury Rehabilitation. Dr. Alavinia, Dr. Giangregorio, Dr. Miyatani, and Lindsie Blencowe report no conflicts of interest.

Figures

Figure 1.
Figure 1.
Risk score calculations for the significant nodes of the classification and regression tree (CART) analysis. Prior_Frag_FX = prior fragility fracture; Yrs_Post_SCI = years post injury.
See this image and copyright information in PMC

References

    1. Gifre L, Vidal J, Carrasco J, et al. Incidence of skeletal fractures after traumatic spinal cord injury: A 10-year follow-up study. Clin Rehabil. 2014;28(4):361–369. doi: 10.1177/0269215513501905. - DOI - PubMed
    1. Carbone LD, Chin AS, Burns SP, et al. Morbidity following lower extremity fractures in men with spinal cord injury. Osteo Int. 2013;24(8):2261–2267. doi: 10.1007/s00198-013-2295-8. - DOI - PubMed
    1. Carbone LD, Chin AS, Lee TA, et al. Thiazide use is associated with reduced risk for incident lower extremity fractures in men with spinal cord injury. Arch Phys Med Rehabil. 2014;95(6):1015–1020. doi: 10.1016/j.apmr.2013.12.013. - DOI - PubMed
    1. Zehnder Y, Luthi M, Michel D, et al. Long-term changes in bone metabolism, bone mineral density, quantitative ultrasound parameters, and fracture incidence after spinal cord injury: A cross-sectional observational study in 100 paraplegic men. Osteo Int. 2004;15(3):180–9. doi: 10.1007/s00198-003-1529-6. - DOI - PubMed
    1. Ragnarsson KT, Sell GH. Lower extremity fractures after spinal cord injury: A retrospective study. Arch Phys Med Rehabil. 1981;62(9):418–423. - PubMed

Substances

LinkOut - more resources