Garland’s research shows that BMD loss after SCI happens in distinct phases: acute - the first four months after SCI subacute - the next 12 months and chronic - from about one and a half years on. It turns out standard scans could be putting people at increased risk for fracture.
ORTHOFIX BONE STIMULATOR SOFTWARE
So we rewrote the DEXA software and began measuring BMD at the knee and compared that to standard DEXA scan results,” says Garland. The SCI spine doesn’t lose bone, and the hip doesn’t lose that much. But osteoporosis in SCI is regional, specifically from the knee on down, which is where most SCI fractures occur. Also, menopause is systemic - it affects all bones. “DEXA scan software is based on postmenopausal women at the spine and hip because that is where they fracture. Garland’s research shows this test is flawed. It is becoming common for PM&R docs to order DEXA bone scans - low energy X-rays that measure BMD at the wrist, spine and hip – to monitor BMD in people with SCI, especially if they have had a fracture. In recent years the physical medicine and rehab community has become more aware of osteoporosis and SCI. A loss of 50 percent BMD is considered the “fracture breakpoint.” These really fragile bones can fracture from minor ovements like stretching, a simple fall from the chair, or even rolling over in bed. Osteoporosis starts when losing 32 percent of BMD puts you in the “fracture threshold.” You run the risk of fracture from a fall, a missed transfer or a tumble out of your chair. A “normal,” healthy 30-year-old measures 100 percent BMD. “The longer you have been injured, the more fragile your bones become.”īone strength is expressed in bone mineral density. “The most crucial piece of information is this: With SCI, your bones get thinner (weaker) from the hip to the knee, and thinner still from the knee to the heel,” Garland says. His background has driven 20 years of research on SCI and osteoporosis - and his current study ties all his experience together. The former director of neurotrauma in the department of surgery at Rancho Los Amigos Rehab Center is in his 30th year as an orthopedic surgeon. Garland’s background gives him unique insight into SCI and osteoporosis. Most importantly, it provides an easy way to figure out fracture risk, and hopefully, avoid a break. His study challenges current testing methods. The numbers never make it into rehab records for study.” Garland recently completed a five-year osteoporosis and SCI study on where bone is lost, how much and how fast. “There are a lot of SCI fractures out there, but they are treated at local doctor’s offices or ERs. Douglas Garland of Memorial Orthopedic Surgical Group in Long Beach, Calif. “Physical Medicine and Rehabilitation didn’t get it,” says Dr. Until recently, dangers posed by osteoporosis in people with spinal cord injuries were, at best, an afterthought.