How is osteoporosis after SCI treated?
Author: SCIRE Community Team | Reviewer: B. Catharine Craven | Published: 11 October 2017 | Updated: 14 March 2019
Vitamin D supplementation may have a role in osteoporosis prevention post-SCI.9
1. Adequate, but not too much Vitamin D intake
Vitamin D is a vitamin that has an essential role in maintaining bone health by increasing the absorption of calcium. After SCI, there are a number of different factors that may contribute to a vitamin D deficiency, including reduced exposure to sunlight, inadequate diet, and side effects from medications metabolized by the liver. Research evidence suggests that vitamin D supplements can help to maintain bone mineral density in the legs after SCI. Your health care team should measure and monitor your vitamin D serum level to ensure it remains in the optimal range.
There are currently no SCI guidelines on vitamin D intake. In Canada, the general recommendation for adults is to consume 600 IU of vitamin D each day or 800 IU each day for those older than 70 years. Osteoporosis Canada recommends that people with osteoporosis, multiple fractures, or conditions affecting vitamin D absorption should aim for 800-2000 IU each day. Intakes greater than 4000 IU per day are not recommended to prevent adverse effects associated with excessive levels of calcium due to its increased absorption by vitamin D.
2. Adequate, but not too much Calcium intake
Calcium is the main mineral in bone and is a common supplement used to treat women with osteoporosis after menopause. Current evidence suggests that calcium supplements alone do not reduce bone loss after SCI. However, calcium and vitamin D are used together to maintain bone density. Additionally, research suggests that high calcium intake achieved by using supplements may be linked to the development of coronary artery calcification (hardening of the heart arteries due to calcium build-up). Increasing calcium intake through food sources instead appeared to decrease this risk. As a result, dietary sources of calcium should be optimized first before considering supplementation.
There are currently no SCI guidelines on calcium intake. In Canada, the general recommendation for adults is to consume 1000-1200 mg of calcium each day or 1200 mg each day for those older than 70 years. Intakes greater than 2000-2500 mg per day are not recommended to prevent adverse effects such as bone pain and kidney stones. If you have stones in your bladder or kidney, calcium intake will need to be lower than that of your peers.
3. Drug Therapy
There are two main treatment approaches that can be taken to osteoporosis after SCI, depending on the length of time since the injury:
Early approaches
Bone loss happens at a faster rate during the first year after SCI, so treatments during this time focus on preventing the loss of bone mineral density by slowing the rate of bone loss. Early treatment may involve oral bisphosphonate medications, which are often started within the first 3 months after injury.
Later approaches
If sublesional osteoporosis occurs of the hip and knee regions (usually after the first year), later treatment seeks to keep or increase hip or knee region bone mineral density. Treatments during this period may include bisphosphonate medications, Denosumab, or Recombinant Parathyroid Hormone (PTH), supplements, and physical treatments. These treatments are based on the assumption that regional increases in bone density will result in a lower fracture risk.