Ask the Doctor about Osteoporosis

General Questions Related to Bone Health and Osteoporosis |
Exercise and Bone Health/Osteoporosis |
Medications and Bone Health/Osteoporosis |
Vitamins/Minerals and Bone Health/Osteoporosis |
Miscellaneous Questions Related to Bone Health/Osteoporosis |

Answers to questions submitted during July 2006. Request for more questions will be asked for in the future.

Disclaimer

"Ask the Doctor" is an informational and educational program provided by National Rehabilitation Hospital ("NRH") to provide general information on spinal cord injury. Information posted on the "Ask the Doctor" site is provided solely for informational and educational purposes only and is not intended nor implied to be the diagnosis or treatment of a medical condition or a substitute for professional medical advice relative to your specific medical conditions. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding your medical condition.

We would like your feedback and suggestions.

Hello – It seems that there are a number of people quite concerned about their bone health AND a number of people engaged in or considering an exercise/physical activity program and concerned about the effect this might have on bone health. I applaud all of you for being so conscientious about your health!!

First and foremost I’d like to refer you to our Consumer Fact Sheet on Osteoporosis at http://www.sci-health.org/RRTC/publications/PDF/Osteo.pdf. This will provide a brief overview of osteoporosis as background information in addition to the specific questions answered in greater detail below.

Note: In some cases some assumptions were made which could have a significant impact on bone health. For example, your current age, age at SCI, level of SCI, and whether the SCI is complete or not are very important factors that relate to bone health. When these were not provided in the question, the response was more general to accommodate a more general audience. Also, the questions have been arranged by major topical areas as these relate to bone health: General, Exercise, Medication, Vitamins/Minerals, Miscellaneous, and Other.

General Questions Related to Bone Health and Osteoporosis

In 2002, a panel of experts was convened by the National Institutes of Health (NIH) to address the following questions: What is osteoporosis and what are its consequences? How do risks vary among different people? What factors are involved in building and maintaining bone health throughout life? What is the best evaluation and treatment of osteoporosis and fractures?

According to the American Academy of Family Practice, “Osteoporosis is a disorder of the skeletal system characterized by weakened bone strength, which results in an increased risk of fracture. In the United States, approximately 10 million people are estimated to have osteoporosis, and another 18 million are at increased risk as a result of low bone mass. Although osteoporosis was once thought to be a disorder that struck primarily elderly women, it is no longer considered to be a natural part of aging or dependent on age or sex.
Patients with osteoporosis have decreased bone strength, lack of bone density and bone quality, and are more prone to fractures. The costs of osteoporosis are financial, physical, and psychosocial. Direct financial expenditures for treatment of osteoporotic fracture are estimated at $10 to $15 billion annually. A fracture can be the result of a traumatic event, such as falling, or it can be the result of normal, everyday activities.
Osteoporosis [has] two main features: bone density (usually expressed as grams of mineral per area or volume) and bone quality (architecture, damage accumulation, and mineralization of the bone). There is no consensus or standardized way to measure overall bone strength, although for young white adult women, the World Health Organization defines osteoporosis as bone density 2.5 standard deviations below the mean.

Predictors of low bone mass include female sex, increased age, estrogen deficiency, white race, low weight and body mass index, family history of osteoporosis, smoking, and history of fracture.

The bone mass attained early in life is perhaps the most important determinant of lifelong [bone] health. Individuals with the highest peak bone mass after adolescence have the greatest protective advantage. Nutrition, exercise, certain steroids [taken for extended periods of time], and growth hormone and body composition all play a role in bone density. Building good eating habits early in life is important. In particular, getting enough calcium and vitamin D is crucial. Exercise, particularly resistance-based and high-impact exercise, is also beneficial because it helps increase bone density.”

Thus, there are certain risk factors for osteoporosis and optimal nutrition and exercise can also help you to maintain bone health. In general, though, osteoporosis is fairly universal after SCI, meaning that the vast majority of people with SCI will have or will develop osteoporosis. We know that within 10 days to 2 weeks after SCI there are markers in the blood and urine that indicate that calcium is being lost from bone. This continues for several months, peaking in the 2-4 month range, but continuing the a lesser extent for up to at least 2 years. There are several x-ray examinations used to diagnose osteoporosis, the most common is DEXA (dual x-ray absorptiometry). This is a very fast, low risk x-ray exam that can be done of either certain parts of the body or the entire body and provides a number that compares your bone density to an age and gender matched “normal” population figure. What that means is that given your gender (females generally have lower bone density than males) and age (beyond adolescence most people’s bone density generally plateau’s then declines) there are varying “normal” or “expected” levels of bone density. Thus, it would not make sense to compare the bone density of an 18 year old male to a 60 year old female.

One issue after SCI is that regardless of age or gender, bone density seems to be lost fairly rapidly. So, within a relatively short amount of time, comparison to these “normative” values starts to lose its importance. Also, we have found that people with SCI tend to lose bone moreso in the legs than the arms, and in the legs, bone density tends to be less in the lower leg and around the knee than in the hip area. In the non-SCI population, we measure bone density in the wrist, low back and hip, because these are common site of bone loss and later fracture. These are not the common sites of bone loss after SCI, however, which again complicates the picture.

Therefore, after SCI, we can still use DEXA to measure bone health, but it is preferred to measure bone density around the knee and some are even measuring it at the ankle. The most common site of fracture after SCI is in the leg area around the knee, so it would make sense that that would be the area we measure and try to increase bone density. In general, if you had good bone density prior to your SCI then you will at least have “extra reserve” at the time of injury. Also, it appears that if you have a motor incomplete injury (meaning that you can move some of the muscles below the level of your injury) then you might be protected to some extent, although some degree of bone loss and osteoporosis is still very likely.

Another important point that is true whether you have an SCI or not is that it is much harder to restore bone that has already been lost than it is to prevent bone from being lost. That is one reason we are trying to use intensive exercise regimens or medications very early after SCI to prevent bone loss. Although we are finding some early promising results, we do not know if any of the benefit seen lasts for years.

Question: “M” is a 31 year old female with a C-5, C-6, T-1 SCI for 9 years and asks: 

• What are your chances of getting Osteoporosis?
• Is it worse the longer you’re hurt or could it happen at any time?
• If you exercise or if you’re active are you still at risk? 
• What type of exercises could I do to prevent Osteoporosis?
• Does your age matter or not?

Answer: Again, osteoporosis is dependent on a number of factors, but after SCI the important factors appear to be how long you have had the SCI, how complete the injury is, and prior bone health. Thus, the chances of getting some degree of osteoporosis approaches 100% for most people with SCI, and it usually begins very early and then continues for at least a few years.

Exercisers are still at risk, but early (intense) exercise may prevent some (but not all) of the bone loss. It is important to realize that this exercise needs to begin in the first weeks to months, which is difficult since this is often the time of intense rehabilitation. Activities that seem to do more to prevent osteoporosis include those that include an element of stress on the bone (standing/walking) and muscle stimulation (electrically). The bone actually strengthens when muscle actively pulls on the bone during contraction.

Age does matter. As you age you tend to have lower bone density whether you have an SCI or not.

Question: I am a 56-year-old male incomplete quadriplegic (C 4-5) 13 years post-injury.  I am very spastic and have a intrathecal baclofen pump.  I am interested in answers to all the questions that were in the e-mail as well as suggestions as to what I should be doing to monitor bone loss. Because of my spasticity it takes a lot of effort to range me and I am concerned that at some point my bones won't be able to handle the force necessary. I appreciate your suggestions.

• Why are persons with spinal cord injury at increased risk for osteoporosis?  Largely because of the lack of upright standing (weight-bearing) AND lack of muscle pulling on the bone, although there may be other factors directly associated with the SCI which we have not identified yet.
• How do you find out if you have osteoporosis?

If you have an SCI you likely have some degree of bone loss (if not technically osteoporosis). To determine if you do have osteoporosis you need to have a DEXA scan done, although it is important for the DEXA to specifically look at the lower leg and the bones around the knee as opposed to the typical hip/spine/wrist combination.

• Can osteoporosis be prevented?

It looks like some degree of the osteoporosis that occurs after SCI can be prevented with some early (in the first weeks to months after injury) treatments (intensive exercise, medications), although we do not know if these have lasting benefits or not.

• Can bone that has been lost be built back up?

At this point our understanding is that this is very difficult to do and if it were to be successful would involve some combination of intensive exercise and medications, but this is yet to be determined.

• How does exercise and physical activity factor in?

There is likely a role for intense exercise, which is in part what we’re trying to define in some of our research. Also, whereas exercise does not at this time seem to restore bone density, it still is likely to prevent further loss even when osteoporosis is already present. This depends very much on the type of exercise, intensity of exercise, etc.

Question: Since I do very little dairy products, due to the calcium deposits in my bladder, what can I take to build my bone density up?  My shoulder socket hurts on my strong side, will heat help?  I can't tell if it's muscle fatigue or joint pain.

Answer: The shoulder pain is likely overuse and could be a combination of muscle/tendon/ligament overuse and possibly arthritis. Not knowing the details of your age and SCI, osteoporosis would be unlikely in your shoulder if you use it to push, transfer, and other activities.

Regarding the kidney or bladder stones, it is important to realize that there are a number of causes of stones (for example, caffeine can contribute to stone formation). It is important to have other causes of stones “ruled-out” before eliminating calcium from the diet.

A typical “kidney stone diet” though, is the following: diet low in animal protein (also reduce milk, yogurt, and cheese) and low salt helps reduce the recurrence of calcium oxalate stones. Most people with calcium stones have a condition called hypercalciuria, in which excess calcium is excreted in the urine. Thiazide diuretics such as trichlormethiazide reduce new stone formation in such people. Drinking large amounts of fluids--8 glasses a day--is recommended. But bladder management has to be taken into account. A high level of oxalate in the urine, which contributes to calcium stone formation, may result from excess consumption of foods high in oxalate, such as rhubarb, spinach, cocoa and chocolate, walnuts, and tea, or from certain intestinal disorders.
Rarely, calcium stones result from another disorder, such as hyperparathyroidism, sarcoidosis, vitamin D toxicity, renal tubular acidosis, or cancer. In such cases, the underlying disorder is treated.

For kidney stones that contain uric acid, a diet low in meat, fish, and poultry is recommended, because these foods increase the level of uric acid in the urine. Allopurinol may be given to reduce the production of uric acid. Potassium citrate may be given to make the urine alkaline, because uric acid stones form when urine acidity increases. Drinking large amounts of fluids also helps.
For struvite stones--which indicate a urinary tract infection--antibiotics are given

Question: I have been diagnosed with Osteopena in the hips.  My physician has instructed me to increase my daily calcium intake to 2000 mg and increase exercising, but says my score is 2.6 and this does not indicate using medication.  I read and hear a lot about medications that will not only slow down bone loss but build bone.  I am concerned that if we wait too long to start medication, I will have significant bone loss.  My family history is: Mother/Osteoporosis in spine; Grandmothers both sides /Osteoporosis in spine; Aunts on both sides/Osteoporosis spine and hip.  Am I worrying for no reason?

Also, what can be done for severe pain associated with osteoporosis if the person is physically unable to exercise?  And/or, what kind of pain control helps in such a case?

Answer: To best answer this it would be helpful to put this information into perspective with your SCI history, specifically, age, age at injury, level, and completeness of injury. If you’ve been injured for many years and have a complete injury your bone density might be relatively stable. If on the other hand, you’ve been more recently injured, then you have a greater likelihood of continued bone loss. Also, it is important to see what your bone density is around the knee. Another problem with the hip DEXA is that arthritis and heterotopic ossification at the hip (commonly seen after SCI) can really alter the results of the DEXA. It might be reasonable for you to get a series of DEXA exams and that might help to put into perspective if you are actively losing bone.

Osteoporosis pain can be difficult to manage and in the non-SCI population a combination of exercise and pain medications has been shown to be effective.

Question: I'm a quadriplegic. Can you tell me in regards to osteoporosis, can you ever build bone density back once it's been depleted?  I have been healing a pressure sore for two plus months now and have been taking protein pills and eating high doses of protein.  Will that help bone density?

Answer: It is very difficult to build bone back up and if this were found to be effective it likely would involve a very intense exercise program (that might include some elements of standing, walking, electrical stimulation, FES, cycling, etc.) that would take place most to all days of the week for anywhere from 1 or more hours per day, and possibly with the addition of medications.

Again, in our research preliminary results show that we can prevent some bone density loss in people with acute complete SCI with 1 hour of electrical stimulation 5 days per week to the legs.

Exercise and Bone Health/Osteoporosis

Question: I have a SCI and work in the outdoor adventure field as well as being a professor in Recreation Therapy at Indiana State University. A concern that I have had for many years is the structural integrity of the hip girdle and femur in persons with SCI and others who use a wheelchair for mobility.

My concern is that these areas of the body may be more prone to injury due to osteoporosis or weakening of connective tissue. When I get people on a ropes course, they are wearing a seat harness that puts stress on the hip girdle and the back of the femur at about the mid point of the bone. In addition to the harness, there is the possibility of swinging into a hard object (platform, tree) and striking the hip or femur. I have heard there are problems with femur fractures in persons with SCI. What concerns should I have about this and what might you suggest as Precautions?

Answer: Two issues come to mind here – given the potential trauma you describe I would be concerned about fracture (depending on the person and the degrees of bone loss described above). Regarding precautions, in someone who has lost a tremendous amount of bone (not uncommon after complete SCI), a “pathologic” fracture will result from a motion or activity that is not necessarily “traumatic”, such as range of motion or moving the leg to tie shoelaces. Given that, considerations might be to screen people as to whether they have previously had fractures or even whether they have had a DEXA to determine bone mineral density. This can still be problematic as we do not necessarily have a good understanding on what is the critical level of osteoporosis, below which the risk of fracture increases substantially. Likely, since this is a recreation/leisure that has other benefits to people, lots of education on the potential risks might be the best option.

Question: I am 11 years post injury, T4 complete. Approximately a year and a half ago, I had leg braces made and now use them 2-3X's a week with a walker.  I was also recently diagnosed with osteoporosis.  What can be done to reverse osteoporosis?  I have been thinking about buying an e-stim box and working my leg muscles to see if it will strengthen my leg bones.  Is there any research out there with positive results?

Answer: Reversing osteoporosis is very difficult. The best goal would be to try to slow/stop bone loss (i.e., prevent further osteoporosis). We are doing some initial research and e-stim seems to slow bone loss in people immediately after injury. There is no convincing evidence that it can restore bone that has already been lost, although there is the prospect that a very intensive program of estim performed on most days of the week might have a minimal positive effect.

Question: I have a T9/10 complete SCI of 23-years.  I have really poor bone density/osteoporosis, especially below the level of injury.  I'm physically active and really TRY to eat healthy.  I have a really strong upper body and keep my weight down.  My question is:  How can exercise assist in "rebuilding" or maintaining bone density below the level of injury?

Answer: Again, exercise alone probably cannot significantly rebuild bone……unless you exercise most of the day for most days, which then will create a new set of problems.

Question: I have a SCI at T-4/5 and exercise on a Nu-Step machine that allows me to operate it with my hands while my legs go along for the ride.  Will this help prevent bone loss in my legs and build muscle mass or prevent atrophy?

Answer: Since this is more passive exercise and the muscles are not necessarily contracting but they are getting some weight-bearing effect, I would doubt that this type of exercise would go far toward preventing or restoring bone loss, although in all fairness, this specific type of exercise has not been investigated for this purpose.

Question: I got this link from the NSCIA website. I am a complete T6 paraplegic, and also a nurse. I am very interested in how standing affects bone density, as well as any other benefits. I stand every day for an hour, and I am wondering if it will help in the long term.
 
Answer: There is some evidence that an early (first few weeks-months) intense program of standing might prevent a small element of bone loss, but bone loss will still occur, and this will likely not restore bone loss.

Question: I am a 47 year old male w/ T-3 paraplegia complete.  I have been a para for 16 years, and was in a serious enough accident that it broke both the tibia and fibula about 8 inches above my ankle 2 years ago.  I was casted 3 times over a period of 7 months, but the bones remained in non-union.  Ultimately I had a rod implanted in the tibia, with the fibula left in non-union.  I did finally receive a bone stimulator post-op and used it religiously for the 3 months it was activated. I have a hand-cycle and ride an average of 30 miles per week, and that is pretty much the extent of my exercise.  I am 6’ 1” and weigh 173 lbs., don’t smoke and drink only occasionally, take baclofen, neurontin, ditripan, and a multivitamin daily. I drink a glass of milk every morning, and usually have another source of calcium at least once more each day. My questions are:

I have a standing chair which I have not used since I broke my leg; is it okay to elevate my standing chair and put my weight on injured leg as repaired?

Answer: It might be wise to have your bone density assessed by DEXA (around the knee and in the lower leg) but again, we do not know a “threshold value” below which standing should not be performed. With that information you might be able to better weigh the risks/benefits of standing for you.

Am I getting enough calcium in my diet, and how do I determine whether I am at risk of developing osteoporosis? 

Answer: Again, I would start with a DEXA to see what your bone health is first. Given that you have an SCI, you are already at risk and probably have some degree of osteoporosis.

What precautions do you suggest I take over the next decade as I continue to age with a SCI? 
Answer:
Continue as you are doing to eat healthy and avoid a lifestyle that might impair bone health. Sounds like you are doing a lot of the right things.

Medications and Bone Health/Osteoporosis

Question: Should people on Fosamax stop taking it, or change the schedule at particular times, due to recent occurrences of significant jaw bone deterioration in patients?

Answer: Fosamax is one of a number of drugs in a class of medications called the “bisphosphonates” that are used for a variety of conditions that involve calcium balance. For example, these are being used more for women with postmenopausal osteoporosis as well as for cancer patients who have altered calcium balance. There have been rare reports of jaw osteonecrosis and/or pain. The FDA states that this risk is highest for people who have been given bisphosphonates intravenously, as opposed to orally.

A consideration for people with SCI might be to make sure you know what your level of bone density is prior to taking this medication and then consider monitoring whether any further bone loss is actually prevented with the use of the medication. For example, for someone who has been injured for 20 years and who has already lost a considerable amount of bone density, use of a bisphosphonate may only provide minimal benefit at best over a long period of time.  Are all of the risks (including cost) worth this benefit to you?

Question: I have had a SCI for several years. I undergo yoga and water aerobics, but these are very gentle and in warm water. My toes already break easily. Is there anything else I should be doing? I take calcium and was on Fosamax but my calcium levels got up with just the calcium so I quit taking it.

Answer: Not knowing level of injury, age, duration of injury, etc., it is unlikely that the exercise that you are currently doing is providing much benefit to your bones, although it is important to remember that there are other benefits to your body/mind. Answering this question depends on your current bone density –  but the best answer is to take in a nutritious diet and exercise regularly.

Question: I am a home care nurse caring for a 19 year old ventilator dependent quadriplegic. He was diagnosed with severe osteoporosis June 2005. He was placed on Actonel, and Calcium supplements ( Oscal 500mg  bid). Then in September  2005 during a routine x-ray, a 3mm calcification right kidney was noted (in January 2005 a renal ultrasound was completed with no sign of kidney stones). So, it was assumed the kidney stone now present was probably caused by the calcium supplement( Oscal).

So my question: What is the best method you have found for a SCI person/non-weight bearing, to treat severe osteoporosis compounded with diagnosis of kidney stones and the potential problems they cause?

Answer: Again, treating osteoporosis, or restoring bone mass after it has been lost is very difficult and honestly, we don’t have a method of doing that at this time. The best advise is for him to maintain a healthy balanced diet, drink plenty of fluids (taking into consideration bladder management) and be as physically active as possible. Remember that there are a number of causes of kidney stones – it would be important to have his urologist assess these before eliminating calcium from the diet, which will obviously have other adverse effects. It is also important to have the osteoporosis quantified (by DEXA) prior to initiating treatment. In that way, you can assess whether the treatment is having any positive effect or not.

Question: Do any of the osteoporosis medications such as Actonel work on people with SCI?

Answer: The bisphosphonates have shown some effectiveness at preventing bone loss early after SCI, although we do not know if these effects last long term. We also do not know the effectiveness of bisphosphonates on restoring bone loss in chronic SCI.

Question: I would like to know if taking a multivitamin and fosamax is usually adequate? I have taken Tums for the calcium but ran into kidney stones from taking them two three times a day. Now I don’t take any extra calcium or Vitamin D except what I get the daily multivitamin.             

Answer: It is based on the individual whether a multivitamin and fosamax are adequate. For example, even a multivitamin and fosamax may not prevent fully the high level of bone loss seen in acute SCI, whereas it may prevent bone loss later in life adequately (because the rate of bone loss has slowed at that point). Whether or not to take fosamax or another bisphosphonate is an individual decision you need to make with your health care provider considering all of your risk factors, lifestyle, etc., and carefully weighing the risks and benefits. The use of these medications is not at this time considered “standard of care” for SCI.

Question: Are you familiar with treating osteoporosis with Zolendronate?  I have had one infusion of Zolendronate 6 months ago; as of yet we don't know its effectiveness.

Answer: Agreed. From a scientific standpoint there are initial indications that bisphosphonates (of which, Zolendronate is one) can help prevent bone loss immediately after SCI, but we cannot comment on bisphosphonates used in chronic SCI to restore bone loss.

Question: Does exercise need to impact lean muscles to be effective?

Answer: To prevent bone loss, it seems to be important to stress the bone to slow loss through weight-bearing and through the effects of muscle contraction on bone.

Question: Will my lower paralyzed limbs respond to exercise and will the bones in my lower limbs be strengthened with exercise?
 
Answer: They can respond to selected forms of exercise (for example, with electrical stimulation, increasing muscle bulk is possible as well as slowing bone loss).

Question: Does exercise of the upper non paralyzed have a positive impact on my body? If so, in what way?

Answer: Exercise has many positive effects on the body, such as reducing the likelihood of obesity, improving blood pressure, and reducing cardiovascular risk. It is unlikely that exercise of the upper body will impart a positive effect on bone density in the lower body, though

Vitamins/Minerals and Bone Health/Osteoporosis

Question: My doctor is encouraging me to take calcium due to my age and beginning signs of osteoporosis. But since I have had kidney stones (ouch!) I am concerned about the calcium causing more stones. When I had one stone removed the doctor wasn't able to test it to determine the kind of stone it was. Does taking calcium potentially cause more stones? And what kind of calcium should one take? I have had a SCI for almost 40 years, am 56 years old, and female.

Answer: The combination of calcium and Vitamin D do appear to prevent bone loss in the non-SCI population. We do not have enough information in the SCI population; therefore utilizing similar recommendations is generally accepted. These include 500 mg of elemental calcium per day and 700 to 800 IU of cholecalciferol.

Whether you develop stones or not depends on amount of calcium intake in addition to other factors (see question above). Make sure there are no other reasons you are developing stones and then you can assess with your health care professional the appropriate amount of calcium intake.

Question: Are calcium supplements in pill/capsule formula "better" than the newer chewables (like Viactiv)? Also, what can you tell me about the jaw bone problems identified with taking Fosomax? What signs would one look for to tell that a problem might be developing?

Answer: For the first 2 questions, see previous questions/answers. Signs and symptoms of jaw osteonecrosis associated with Fosamax include: jaw pain or inflammation, gums that don’t heal, loosening teeth, or a feeling of numbness or heaviness in the jaw.

Question: How is calcium available to someone with osteo and is not able to tolerate calcium and is lactose intolerant?

Answer: Good options might include calcium-fortified orange or apple juice, and calcium-fortified cereals and breads. Ask your doctor or dietitian about taking calcium supplements

Miscellaneous Questions Related to Bone Health/Osteoporosis

Question: I am a 36-year-old male C5-6 SCI.  I am 2 1/2 years post with osteoporosis. I had a dexa scan at 1 1/2 years and had a young T-score of -3.7 in the femur neck area.  I started taking Actonel and standing for 45 minutes a day.  A year later I had another dexa scan and lost another 12%.  My doctor has now recommended Forteo but I have not found a lot of information on it. I have also read about vibration therapy using a powerplate.  Please let me know if you have any information on these two suggestions or any recommendations.  I appreciate your help.
 
Answer: Again, the additional 12% bone loss despite Actonel is not totally surprising given that you are still in a more active phase of bone loss. Forteo is a synthetic form of parathyroid hormone, which is felt to play a role in SCI-related bone loss. There are a few studies that are being initiated looking at this drug, but we certainly have no conclusions yet.

Question: What a timely topic!  I just purchased a standing frame, a Glider from Altimate Medical that stands you up and gives active motion to the hips by pushing handles forward and back.  It was recommended that I have a bone scan done prior to getting the Glider, but was given no guidelines saying, “If the scan comes back with X, then do Y” or “You must have a minimum of X to use the Glider safely”.  I have osteopenia (not quite osteoporosis) in one hip at the neck of the femur, and just into the osteopenia range in the other femur neck.  Is it dangerous to stand with these diagnoses?  I am a T-12 para from 1980, in great physical shape, only slight hip flexion contractures.
 
Answer: I want to know the “X” and “Y” as well, but unfortunately we don’t have those answers yet. Some people in rehabilitation are recommending against standing/walking activities in people whose DEXA reveals bone density less than -2.5 whereas others recommend going as low as -3.5 to -4 is probably safe in controlled conditions, but again, the data is really lacking here. Again, it might be helpful to have that DEXA done looking a little lower in the leg, specifically around the knee.

Question: How can a person with a spinal cord injury and on SSI (read: no money) continue to decrease loss of function...any exercise, food, whatever that will help maintain health and movement?

Answer: This can be very difficult, especially with limited resources. The best things are to do your best to maintain as healthy a lifestyle as possible. This means eating a healthy and balanced diet and exercising. This doesn’t have to cost a lot of money. In some of our studies, people are able to exercise at or near their homes using hand weights, exercise videos, bands, and other inexpensive aids to get a good workout. Also, avoiding becoming overweight and the secondary conditions that go along with that is extremely important. Another point, though, is if you feel that you have lost function then it is important to have an evaluation by an SCI specialist to make sure that nothing else is going on to cause the loss of function.

Question: My question is how dangerous is to have arthritis on the T-3 disk? Will this affect the cord?

Answer: This depends on the location and magnitude of the arthritis. This can easily be answered by a back specialist after the appropriate x-rays have been completed.

Question: My brother has been a quadriplegic for 38 years.  For the last year he has had pain around his hip and buttock area and just recently his back. The hip and buttock area he has attributed to skin sensitivity and is extremely afraid of getting a sore. His attendant turns him every hour to hour and a half every night. His attendant lives with him 7 days a week and does not have a day off. He has tried several different mattresses. My family thinks it might be more than his skin. He refuses to take any pain meds because he wants to know if he might be developing a sore. Please help! We are frustrated and exhausted beyond belief.

Answer: This pain could have several causes, such as skin problems, neurologic, or other. It would probably be worth it for him to see his SCI specialist to talk more about the pain and to try to come up with a reasonable treatment approach. It certainly seems that the pain is adversely affecting many people’s lives at this point.