Comparative Analysis of Bone Mineral Density between Wheelchair-bound versus Wheelchair Athletes with Spinal Cord Injury Using Quantitative Ultrasound

Abstract Background: Spinal cord injury (SCI) leads to a profound decrease in bone mineral density (BMD), particularly below the neurological level of injury. Substantial bone loss was observed within the first 6 months post-injury with a prevalence exceeding 80% in long-term follow-ups. The aim was to compare BMD in sedentary SCI patients with those involved in wheelchair sports. Materials and Methods: Quantitative ultrasound (QUS) assessment of bone mineral density in SCI patients was done using SONOST-2000 bone densitometer. A total of 39 SCI patients confirmed to inclusion criteria were divided into two groups: 11 wheelchair sports athletes (Group I) and 28 non-athletic patients (Group II). The QUS assessed BMD by measuring the t -score at the calcaneus of SCI patients. Results: Both groups showed significantly low t -scores, but no statistical difference in BMD was found between the athletic and non-athletic groups ( P = 0.194). When loss of BMD was correlated with age irrespective of group, no significant correlation ( P = 0.685) was observed across groups. The findings indicate that wheelchair athletes involved in upper-limb sports also have significant BMD loss and are at risk for osteoporosis and fractures. Conclusion: This study highlights the need for routine BMD screening for all SCI patients, including athletes, as part of rehabilitation management. QUS is presented as a cost-effective, accessible alternative to dual X-ray absorptiometry for mass screening of osteoporosis in SCI patients.