Turkish Journal of Physical Medicine and Rehabilitation 2010 , Vol 56 , Num 2

Osteoporosis and Heterotopic Ossification in Patients with Spinal Cord Injury

Ebru Şahin 1 ,Özlen Peker 2
1 Dokuz Eylül Üniversitesi Tıp Fakültesi, Fizik Tedavi ve Rehabilitasyon Anabilim Dalı, İzmir, Türkiye
2 Dokuz Eylül Üniversitesi Tıp Fakültesi, Fiziksel Tıp ve Rehabilitasyon Anabilim Dalı, İzmir
DOI : 10.4274/tftr.56.s75

Osteoporosis is an important complication of spinal cord injuries. Trabecular bone is more affected. The pattern of bone loss in spinal cord injury (SCI) patients is different from that in osteoporosis which occurs as a result of other etiologies such as endocrine diseases, nutritional and drug-related disorders. Rehabilitation interventions include standing and walking exercises, electrical stimulation, low-intensity pulsed ultrasound, vibration and pulsed electromagnetic fields. Calcium, vitamin D, calcitonin and bisphosphonates are the pharmacological therapies. In SCI patients, the incidence of heterotopic ossification, radiologically or clinically detected, ranges from 10 to 53%. Etiology is not yet clear. After SCI, the hip is the most common site of heterotopic ossification, followed by the knee, elbow and shoulder. Humoral, neuro-immunological and local factors play a role in the pathophysiology. Three-phase bone scan with technetium (Tc)-99m-labeled methylene diphosphonate is used in the early diagnosis. Elimination of risk factors and prophylaxis are important detearminants of treatment. Bisphosphonates, indomethacin, radiation, surgical resection are the other treatment options. 

Keywords : Spinal cord injury, osteoporosis, heterotopic ossificatio