Comparison of the prevalence of osteoporosis in people with spinal cord injury according to bone mineral density reference values for the diagnosis of osteoporosis

Abstract

Abstract Background This study aimed to compare the osteoporosis prevalence among Korean adults aged ≥ 50 years with spinal cord injury (SCI) according to bone mineral density (BMD) reference values (BMDRV) for diagnosing osteoporosis. Methods This retrospective cross-sectional study included 855 SCI patients who underwent BMD tests of the lumbar spine, femoral neck, and total hip in the National Rehabilitation Center in Korea between 2010 and 2020.Osteoporosis was diagnosed in SCI patients by comparing differences in prevalence, diagnostic consistency, and risk factors according to the region-based BMDRV of the dual-energy x-ray absorptiometry (DXA) manufacturer and international BMDRV according to the Third National Health and Nutrition Examination Survey (NHANES III) data of females aged 20–29 years. Results The prevalence of osteoporosis according to the T-score provided by a single reference population of the NHANES (PONHA) (males: 26.69%; females: 69.35%) was significantly higher in females and males than the prevalence of osteoporosis according to the T-scores provided by the DXA manufacturer (PODXA) (males: 15.32%; females: 43.15%). The lumbar spine and femoral neck were major osteoporosis diagnosis sites for the PODXA and PONHA, respectively. Risk factors for osteoporosis differed based on the probability of osteoporosis (also called the OZ ratio) according to the BMD criteria; however, risk factors were the same based on old age, female sex, low BMD, and long SCI period. No significant relationship was noted between different SCI-related clinical factors (p > 0.05) Conclusions Further studies on BMDRV are warranted to establish accurate diagnostic criteria for preventing osteoporosis in patients with SCI.