Deteriorated geometric structure and strength of the midfemur in men with complete spinal cord injury.
Abstract
Spinal cord injury (SCI) results in a dramatic loss of bone mineral and a marked increase in fracture incidence in the femur; however, its effect on the femur's geometric structure and strength is poorly studied. The primary purpose of the present study was to assess the geometric structure, composition, and strength of the midfemur in men with long-term (>2 years), complete SCI (C6-L1 level; n=7) relative to men without SCI (n=8). T1-weighted axial images of the thigh were collected on a GE 1.5-T magnetic resonance imager and geometric, structure, composition, and strength measurements of the midfemur and skeletal muscle volume of the midthigh were determined. Areal bone mineral density (aBMD), bone mineral content (BMC), and bone area of the midthird of the femur and arms were determined using dual-energy X-ray absorptiometry. There were no differences in age, height, weight, femur length, arm BMC, arm aBMD, or arm bone area between the SCI group and controls. While the volume of the midfemur was not different in the two groups, the medullary cavity had 53% more volume and was 21-25% wider in the SCI group (P<0.05). In contrast, the cortical wall in the SCI group had a 24% lower volume and was 27-47% thinner (P<0.05). The cortical wall was particularly thin in the posterior section of the bone. The SCI group also had lower BMC and aBMD in the midfemur (21% and 25%, respectively, P<0.05). Calculated cross-sectional moment of inertia (CSMI), section modulus (Z), and polar moment of inertia (J) were lower in the SCI group (13-19%, P<0.05). A higher ratio of cortical bone volume to muscle volume and BMC to muscle volume in the SCI group (P<0.05) suggests that there was a greater loss of muscle than cortical bone after SCI; however, muscle volume was strongly correlated with cortical bone volume and BMC in the SCI and control groups (r=0.71 to 0.90, P<0.05). Muscle volume was also moderately to strongly correlated with CSMI and Z in the anterior-posterior direction and J. Muscle volume was weakly correlated or not correlated with bone strength measures in the control group (P>0.05). These findings suggest that after SCI, the midfemur erodes on the endosteal surface, resulting in a decreased resistance to bending and torsion. Although midthigh muscle volume appears to decline to a greater degree than midfemur cortical bone volume and BMC, their relationships remain strong.
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Spinal cord injury is associated with decreased BMD, increased fracture risk, and deterioration of cortical geometry.
“Spinal cord injury is associated with decreased BMD, increased fracture risk, and deterioration of cortical geometry (270, 271).”
From Receptor Activator of Nuclear Factor κB Ligand and Osteoprotegerin Regulation of Bone Remodeling in Health and Disease (2008) · cites this paper as [270]
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- Authors
- Modlesky, C. M., Slade, J. M., Bickel, C. S., Meyer, R. A., & Dudley, G. A.
- Affiliations
- University of Delaware (US)
- University of Georgia (US)
- Michigan State University (US)
- Corresponding author
- Modlesky, Christopher M.
- Venue
- Bone
- Publisher
- Elsevier BV
- Published
- 2005-02
- Volume
- 36
- Issue
- 2
- Pages
- 331-339
- ISSN
- 1873-2763 (ISSN-L)
- 8756-3282
- OpenAlex
- W2027308735
- Cited by
- 67
- References
- 40
- Citations by year
- 2025: 2 · 2024: 1 · 2023: 1 · 2022: 3 · 2021: 2 · 2020: 1 · 2018: 1 · 2017: 2 · 2016: 3 · 2015: 10 · 2014: 5 · 2013: 3 · 2012: 5
- FWCI
- 5.14
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Bone (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (5r03hd040323-02)
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (HD 40323)
- Topics
- Health Sciences › Medicine › Orthopedics and Sports Medicine › Bone health and osteoporosis research
- Health Sciences › Medicine › Pathology and Forensic Medicine › Spinal Cord Injury Research
- Health Sciences › Medicine › Physiology › Spaceflight effects on biology
- Keywords
- spinal cord injury, femoral geometry, bone strength, bone mineral density, cortical bone thinning, medullary cavity, cross-sectional moment of inertia, section modulus, polar moment of inertia, muscle volume, bone loss, fracture risk, men, bone composition, skeletal muscle atrophy
- MeSH terms
- Adult, Cervical Vertebrae, Femur, Humans, Lumbar Vertebrae, Male, Spinal Cord Injuries, Bone Density
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