Until recently, dangers posed by osteoporosis in people with spinal cord injuries were, at best, an afterthought. “Physical Medicine and Rehabilitation didn’t get it,” says Dr. Douglas Garland of Memorial Orthopedic Surgical Group in Long Beach, Calif. “There are a lot of SCI fractures out there, but they are treated at local doctor’s offices or ERs. 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. His study challenges current testing methods. Most importantly, it provides an easy way to figure out fracture risk, and hopefully, avoid a break.
Garland’s background gives him unique insight into SCI and osteoporosis. 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. His background has driven 20 years of research on SCI and osteoporosis — and his current study ties all his experience together.
“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. “The longer you have been injured, the more fragile your bones become.”
Bone strength is expressed in bone mineral density. A “normal,” healthy 30-year-old measures 100 percent BMD. 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 loss of 50 percent BMD is considered the “fractur