Prevalence and Impact of Fractures in Persons with Spinal Cord Injuries: A Population-Based Study Comparing Fracture Rates between Individuals with Traumatic and Nontraumatic Spinal Cord Injury

Background: Musculoskeletal complications are one of the most common reasons for a patient with a spinal cord injury (SCI) to be rehospitalized. Bone loss due to immobilization and changes in metabolic processes because of the SCI lead to an increased risk of fractures. Objective: To evaluate the prevalence and demographic characteristics of people living with an SCI who had a secondary fracture. Methods: We used population health administrative data from Ontario, Canada, in individuals with either traumatic (TSCI) or nontraumatic SCI (NTSCI). Records of duplicate cases, missing unique patient identifier numbers, individuals not eligible for provincial health insurance, and age <18 years were excluded. Only records of fractures treated in the emergency department or acute care hospital were included. Descriptive statistics were used to summarize data, using counts and percentages that described the numbers and proportions of fractures by type disaggregated by sex, age groups, and type of SCI. Results: A total of 14,168 unique records were identified with 4486 as TSCI and 9682 as NTSCI between April 1, 2004 and March 31, 2020 and were followed up to March 31, 2021. Overall, 11% of the cohort had a subsequent fracture with no difference between TSCI and NTSCI. Hip fractures accounted for 21% of the fractures, wrists accounted for 12%, spine 11%, and tibia 11%. The average time to the first subsequent fracture after the SCI was 3.97 (SD 3.4) years. Conclusion: Monitoring and management of fracture risk needs attention in the first 2 years, with a focus on NTSCI.