Different approach to bone mineral density in non-traumatic spinal cord injury: a comparison with traumatic spinal cord injury.

This was a single-centre retrospective chart review, so it cannot show that non-traumatic SCI causes bone loss. The groups differed at baseline in age, sex, BMI, pre-injury alcohol use, smoking, time since injury, neurological level, and independence scores, so bone-density differences may reflect these differences rather than injury cause. The paper reports 1,636 eligible participants but Table I analyses 1,634; 2 unknown aetiology cases are mentioned, but the count difference is not fully reconciled. Important bone-density factors were not collected, including diet, family history, chronic kidney disease, hyperthyroidism, glucocorticoid therapy, and teriparatide. Spinal degenerative changes, osteophytes, aortic calcification, severe scoliosis, and vertebral fractures could affect lumbar DXA values but were not accounted for. DXA sites were limited by insurance to lumbar spine, femoral neck, and total hip, while SCI guidelines recommend total hip, proximal tibia, and distal femur, so higher-risk fracture sites were not measured. Two DXA machines were used before and after January 20, 2019, with standardization formulas, but machine change remains a possible source of error. One time-since-injury result is labelled significant despite p = 0.054, which is above the stated p < 0.05 threshold.

The authors have no conflicts of interest to declare.

Do not read this as evidence that non-traumatic spinal cord injury causes osteoporosis or that lumbar spine screening will improve outcomes. It is a cross-sectional chart comparison, not an intervention study, and it cannot separate injury cause from age, sex, BMI, injury severity, or other unmeasured factors.