Them Bones, Them Bones and the Spinal Cord Injured

Credit: Mitzie Bower

The term “Osteoporosis”……what comes to mind?  An elderly person?  Post-menopausal woman? But what does bone density loss mean to the spinal cord injured individual?  Actually it’s quite an important term since we no longer use our legs or extremities as we once did prior to our injury. This article was assisted by a fellow nurse who is also spinal cord injured and is being treated for osteoporosis.  So I tapped into her knowledge for constructing this topic.
Osteoporosis is loss of minerals in the bones that makes them weak and prone to breaking. It is not only a common complication for people with SCI, but it’s a common diagnosis to all of who is spinal cord injured.   There has been a great deal of discussion on this topic lately since a lot of SCI people want to remain active but have run into complications with their joints, bones, etc.  
In the time period shortly after the spinal cord has been injured the bones may start to lose calcium for reasons not yet fully identified.  That and the inability to put weight on the bones of the body is a set up for osteoporosis.  Many SCI’s have found that by just transferring into bed can cause a bone to crack or simply exercising and a bone snaps.  The question is why???


Risk factors for osteoporosis according to WebMD:
1. Family history
2. Medications
3. Certain health issues
4. Lifestyle factors:
  • Smoker
  • Alcohol
  • Little or no exercise
  • Type 2 diabetes
  • High blood pressure
  • Lack of calcium-fortified foods
  • Coronary artery disease
  • Small-framed or heavy (weight management)
  • Thyroid conditions
  • Family history
  • Bedridden or inactive for long periods of time
Ok….this is the important part…..”inactive for long periods of time” or “little or no exercise”.   Most of us fall into this category being spinal cord injured.  So we know we are all at risk for osteoporosis but what does that really mean?  What is the definition of osteoporosis, we all hear it but what does it mean?  Osteoporosis is a disease that makes your bones thin, brittle, and easy to break. It's related to the loss of bone mass that happens as a natural part of aging. It's most common in women who have gone through menopause, but it can also occur in men.



I’m not here to reinvent the wheel. There is an excellent article on United Spinal Association written by Jelena Svircev, MD titled Osteoporosis and spinal cord injured found at http://www.spinalcord.org/resource-center/askus/index.php?pg=kb.page&id=1581.  But I want to make you aware what osteoporosis is and how it affects the spinal cord injured individual.   There is a lot of information in that one article but I want to break it down and make it easier to understand.  
By looking at the attached picture, osteoporosis is a porous bone, meaning it is easier to break.




The Rollin RN tries to make these topics easier to understand.  Either these topics were not discussed in rehab or you were so overwhelmed by information, you don’t remember.   Trust me, I get it, I slept through most of my rehab classes due to the effects of pain meds and the strenuous routine of rehab.  So I want to reintroduce topics to help aid the spinal cord injured individual.  This is no different.  Osteoporosis may occur as early as six weeks post-SCI.  Wow….that’s fast.  So the bones can start breaking down while still being hospitalized.   
Extremities are not being used and therefore lack stimulation and bone density minerals are lost. Makes sense, complete SCI individuals can experience higher bone loss than an incomplete.  Makes me wonder if manual chairs versus power chairs make a difference in bone loss too……hmmm? Points to ponder.  
Simple recommendations to aid in bone loss:
  • Healthy diet
  • Supplement calcium
  • Vitamin D supplement (Vitamin D aids in the absorption of calcium)
  • Decrease or stop smoking, alcohol, and caffeine.
After reading and researching multiple articles, the findings are the same…..osteoporosis is unable to be totally prevented in the spinal cord injured individual.   Health care providers may suggest other means to slow down the progression but bones will become brittle due to not being used as previously.  There are treatments that can help the bones. Calcium supplements and dairy foods will help but only to a certain point. The complication of adding too much calcium can cause bladder and kidney stones, so supplements should be addressed with a healthcare professional before taking them. Vitamin D allows the body to better absorb calcium and sometimes that is all that is needed. If you have been diagnosed with osteoporosis, there are a variety of medications that can be prescribed. Some of these medications come in pill form while others come in injection or IV form. They may be taken daily, quarterly, semiannually or yearly depending on the medication.  These medicines come with a possibility of side effects so it is very important to discuss the options with a health care provider.  The goal for most of most of these medicines is to help bones stay as strong as possible.
Exercise in itself is an activity that can help bones maintain strength. This is because exercise puts weight or resistance to the long bones of the body. Ways for individuals to exercise include stretching, range of motion, standing in a standing frame, activity based exercises and vibration. Repetitive movement along with some resistance will improve bone density.
This was an eye-opening research to me.  I have never had Vitamin D or Calcium blood levels drawn nor have they ever been suggested to me to have them drawn.  There is also a simple, noninvasive test that the doctor can order called a bone density test.  The individual lies on a table and a machine automatically moves to scan the body using low-level x-ray.  The bones are measured for density include the wrist, hip, and lumbar spine.  A positive result means normal bone density.  Low bone density is diagnosed as osteopenia.  This means the bones are not as strong as they should be but are not at the point of breaking without significant force being applied.  This is a warning to start building up bone density. Osteoporosis is diagnosed when bone density is in the low range. With a diagnosis of osteoporosis, bone structure looks more like netting. Since the makeup of the bone is no longer solid, a break in the bone is more likely without much pressure applied to the bone. Unfortunately, osteoporosis most likely cannot be cured because lost minerals cannot be brought back into the bones.  It’s better to find ways to prevent further bone loss.
We, as SCI population, must become proactive and suggest testing be done and request recommendations for treatment once results are revealed.  This is just another ‘thang" to watch being spinal cord injured.  Men listen up too.  We must rely on our own knowledge and resources to maintain our own health.  Please check with your own health care provider.
It’s all good,
Patty Kunze, RNC, BSN
Roberta Palmer, RN
The Rollin’ RN ™

References:
Bone loss in the spinal cord injured and multiple sclerosis.  Obtained March 19, 2017 from http://cirrie.buffalo.edu/encyclopedia/en/article/340/.
Osteoporosis and SCI.  Obtained on March 15, 2017 from http://www.spinalcord.org/resource-center/askus/index.php?pg=kb.page&id=1581.
Osteoporosis Risks Factors – Topic Overview.  Obtained March 16, 2017 from http://www.webmd.com/a-to-z-guides/tc/osteoporosis-risk-factors-topic-overview#1.
Understanding Osteoporosis – Diagnosis and Treatment  http://www.webmd.com/osteoporosis/guide/understanding-osteoporosis-treatment#.

Patty Kunze has been a Registered Nurse since 1983.  She holds a Bachelor’s of Science Degree in Nursing and worked several years in a Spinal Cord Injury Unit at the local Veterans Administration Medical Center as a new graduate.  She has been a flight transport nurse for Neonatal Intensive Care, an assistant manager of Labor and Delivery, and an instructor of nursing students. In 2009, she was involved in an auto accident which left her paralyzed (T3-4 complete paraplegic) from chest down.  But she continues her nursing career while sitting in her wheelchair as a nurse paralegal and writing articles for others with spinal cord injuries as The Rollin RN ™.



Roberta Palmer has been a Registered Nurse for 20 years.  She has knowledge in Family Practice, Allery and Immunology, Special Pharmacy Medication and Counseling, and she is a RN Health Coach. In 2014, she was involved in an ATV accident which also left her paralyzed (T3-4 complete paraplegic) from chest down.

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