Burden and risk stratification of osteoporosis in traumatic spinal cord injury: Evidence from a national claims database

OBJECTIVE: spinal cord injury (SCI) is associated with rapid bone loss and a high risk of osteoporosis-related complications. However, population-level data describing the burden of clinically recognized osteoporosis among individuals with SCI are limited. This study aimed to estimate the nationwide burden of medically attended osteoporosis and to identify high-risk subgroups among individuals with traumatic SCI in Korea. DESIGN: Nationwide retrospective claims-based cohort study. METHODS: Using National Health Insurance Service claims data from 2010 to 2019, individuals with traumatic SCI were identified based on ICD-10 diagnostic codes and healthcare utilization criteria. Osteoporosis was operationally defined as clinically recognized osteoporosis, identified through ICD-10 codes (M80-M82) accompanied by repeated inpatient or outpatient encounters. Demographic, socioeconomic, and disability-related factors associated with osteoporosis were examined using multinomial logistic regression. RESULTS: In 2019, 12.0% of individuals with SCI had medically attended osteoporosis, a prevalence substantially higher than that observed in the general population (5.5%). The burden of osteoporosis increased with age and was markedly higher in women (26.2%) than in men (6.6%). After adjustment for demographic and disability-related factors, older age (≥65 years), female sex (adjusted odds ratio (OR) 4.02, 95% CI 3.19-5.07), health insurance status, and internal organ disability were independently associated with higher odds of osteoporosis. CONCLUSION: This nationwide claims-based study demonstrates a substantial burden of clinically recognized osteoporosis among individuals with traumatic SCI, with pronounced disparities by age, sex, and disability type. These findings highlight high-risk subgroups that may benefit from targeted screening and preventive strategies within SCI care, even in the absence of bone mineral density measurements.