MON-810 The Complexities of Osteoporosis in Spinal Cord Injury: Diagnosis, Management, and Multidisciplinary Care

Abstract Disclosure: S. Mitra: None. L.Y. Melendez-Ramirez: None. Introduction: Osteoporosis (OP) following spinal cord injury (SCI) results from rapid bone loss due to disuse, hormonal and neurovascular changes, primarily affecting weight-bearing bones below the level of injury, with an increased risk of fractures. This case highlights the multifactorial pathophysiology of SCI-associated OP and the challenges in its management. Case Description: A 30-year-old male with quadriplegia secondary to a C4 SCI from a gunshot wound at age 20 was referred for evaluation of OP detected during the workup of a chronic decubitus ulcer. His medical history included neurogenic bowel and bladder, spastic paralysis with an intrathecal baclofen pump, and chronic vitamin D deficiency. He had no history of falls, fragility fractures, prolonged corticosteroid use, or thyroid/parathyroid dysfunction. Bone densitometry revealed severe OP with T-scores of -4.5 at right and -4.9 at left femoral necks. Laboratory tests showed low 25-OH vitamin D and elevated N-telopeptide levels. Initial management included calcium and vitamin D supplementation. After discussion of available therapies, initiation of treatment was delayed due to concerns for osteomyelitis, suggested by MRI findings and patient was lost to follow-up. Discussion: Accelerated bone loss begins immediately after SCI occurring below the level of injury with several factors affecting its severity including age, sex, level of injury and degree of loss of motor function . Within two years, most individuals will develop OP, making early screening, diagnosis and treatment essential to prevent fractures in this population. Recommendations for optimal evaluation and treatment of OP in SCI are still emerging in regard to optimal screening tools, initiation of therapy for prevention, use of therapeutic agents and timing of discontinuation of therapy. The International Society of Clinical Densitometry recommends initial screening in SCI with DXA scan as soon as patient is medically stable, followed by serial scans at 1- to 2-year intervals. Evaluation and treatment of secondary causes should be done. Combination therapy with bisphosphonates or denosumab has shown superior outcomes compared to monotherapy with vitamin D alone. Teriparatide and abaloparatide, though effective in increasing BMD, may have lower efficacy in SCI.A multidisciplinary approach is essential to management OP in SCI including nutrition and physical therapy modalities that attenuate BMD loss. General physicians should maintain a high index of suspicion for OP in SCI patients, as early recognition and intervention are key to preventing fractures and improving patient outcomes. References: Poku C, Fedorko J, Weaver FM. Optimal Management of Osteoporosis in the Spinal Cord (Injury) Population. Endocrinol Metab Clin North Am. 2024 Dec;53(4):585-596. doi: 10.1016/j.ecl.2024.08.004. Epub 2024 Sep 25. PMID: 39448138. Presentation: Monday, July 14, 2025