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Diagnosis of bone loss at the distal femur and proximal tibia in persons with spinal cord injury
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Cirnigliaro, Christopher. Diagnosis of bone loss at the distal femur and proximal tibia in persons with spinal cord injury. Retrieved from https://doi.org/doi:10.7282/t3-wsfr-t062

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TitleDiagnosis of bone loss at the distal femur and proximal tibia in persons with spinal cord injury
NameCirnigliaro, Christopher (author); Myslinski, Mary Jane (chair); Rutgers University; School of Health Professions
Date Created2021
Other Date2021-05 (degree)
SubjectSpinal cord injury, Health Sciences
Extent1 online resource (197 pages)
DescriptionObjectives: Persons with traumatic spinal cord injury (SCI) have severe bone loss below the level of lesion with the distal femur (DF) and proximal tibia (PT) being the skeletal regions appreciated to have the highest risk of fracture. While a reference areal bone mineral density (aBMD) database is available at the total hip (TH) using the combined National Health and Nutrition Examination Survey (NHANES) III study and General Electric (GE) combined (GE/NHANES) to calculate T-score (T-scoreGE/NHANES), no such reference database exists for aBMD of the DF and PT. The primary objectives of this study were (1) to create a reference dataset of young-healthy able-bodied (YHAB) persons to calculate T-score (T-scoreYHAB) values at the DF and PT, (2) to explore the impact of time since injury (TSI) on relative bone loss in the DF and PT regions using the two computation models to determine T-score values, 3 and (3) to determine agreement between T-score values for a cohort of persons with SCI using the T-scoreYHAB and T-scoreGE/NHANES reference datasets. Participants: A normative reference aBMD database at the DF and PT was collected in 32 male and 32 female Caucasian YHAB participants (n=64) and then applied to calculate T-score values at the DF and PT in 105 SCI participants from a historical cohort. The SCI participants were then grouped based on TSI epochs (E-I: TSI < 1y, E-II: TSI 1-5y, E-III: TSI 6-10y, E-IV: TSI 11-20y, E-V: TSI > 20y). Main Outcome Measures: The knee and hip aBMD values were obtained by dual energy X-ray absorptiometry (GE Lunar iDXA). Results: There were no significant differences in mean aBMD values across the four YHAB age subgroups at the TH, DF, and PT, and mean aBMD values were higher in men compared to the women at all skeletal regions of interest. Using the mean YHAB aBMD values to calculate T-score values at each TSI epoch for persons with SCI, T-score values decreased as a function of TSI and continued to decline for 11-20 years (E-IV epoch). Moderate kappa agreement was noted between the YHAB and the World Health Organization (WHO) reference datasets for the T-score cutoff criteria accepted to diagnose osteoporosis (e.g., SD <-2.5). Conclusions: A homogeneous reference dataset of YHAB aBMD values at the DF and PT was applied to calculate T-score values in persons with chronic SCI. There was a moderate level of agreement at the TH between the GE/NHANES and YHAB reference datasets when applying the conventional T-score cutoff value for the diagnosis of osteoporosis.
NotePh.D.
NoteIncludes bibliographical references
Genretheses, ETD doctoral
Persistent URLhttps://doi.org/doi:10.7282/t3-wsfr-t062
LanguageEnglish
CollectionSchool of Health Professions ETD Collection
Organization NameRutgers, The State University of New Jersey
RightsThe author owns the copyright to this work.
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