{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,2]],"date-time":"2026-04-02T11:28:19Z","timestamp":1775129299271,"version":"3.50.1"},"reference-count":200,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2023,6,8]],"date-time":"2023-06-08T00:00:00Z","timestamp":1686182400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100009157","name":"NIDILRR, Department of Health and Human Services","doi-asserted-by":"publisher","award":["90SIMS0008-01-00"],"award-info":[{"award-number":["90SIMS0008-01-00"]}],"id":[{"id":"10.13039\/100009157","id-type":"DOI","asserted-by":"publisher"}]},{"name":"UHN Foundation","award":["90SIMS0008-01-00"],"award-info":[{"award-number":["90SIMS0008-01-00"]}]},{"name":"SCI Ontario","award":["90SIMS0008-01-00"],"award-info":[{"award-number":["90SIMS0008-01-00"]}]},{"name":"Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development","award":["90SIMS0008-01-00"],"award-info":[{"award-number":["90SIMS0008-01-00"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JPM"],"abstract":"<jats:p>Background: The prevention of lower extremity fractures and fracture-related morbidity and mortality is a critical component of health services for adults living with chronic spinal cord injury (SCI). Methods: Established best practices and guideline recommendations are articulated in recent international consensus documents from the International Society of Clinical Densitometry, the Paralyzed Veterans of America Consortium for Spinal Cord Medicine and the Orthopedic Trauma Association. Results: This review is a synthesis of the aforementioned consensus documents, which highlight the pathophysiology of lower extremity bone mineral density (BMD) decline after acute SCI. The role and actions treating clinicians should take to screen, diagnose and initiate the appropriate treatment of established low bone mass\/osteoporosis of the hip, distal femur or proximal tibia regions associated with moderate or high fracture risk or diagnose and manage a lower extremity fracture among adults with chronic SCI are articulated. Guidance regarding the prescription of dietary calcium, vitamin D supplements, rehabilitation interventions (passive standing, functional electrical stimulation (FES) or neuromuscular electrical stimulation (NMES)) to modify bone mass and\/or anti-resorptive drug therapy (Alendronate, Denosumab, or Zoledronic Acid) is provided. In the event of lower extremity fracture, the need for timely orthopedic consultation for fracture diagnosis and interprofessional care following definitive fracture management to prevent health complications (venous thromboembolism, pressure injury, and autonomic dysreflexia) and rehabilitation interventions to return the individual to his\/her pre-fracture functional abilities is emphasized. Conclusions: Interprofessional care teams should use recent consensus publications to drive sustained practice change to mitigate fracture incidence and fracture-related morbidity and mortality among adults with chronic SCI.<\/jats:p>","DOI":"10.3390\/jpm13060966","type":"journal-article","created":{"date-parts":[[2023,6,8]],"date-time":"2023-06-08T02:58:32Z","timestamp":1686193112000},"page":"966","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":21,"title":["The Pathophysiology, Identification and Management of Fracture Risk, Sublesional Osteoporosis and Fracture among Adults with Spinal Cord Injury"],"prefix":"10.3390","volume":"13","author":[{"given":"Beverley Catharine","family":"Craven","sequence":"first","affiliation":[{"name":"KITE Research Institute, 520 Sutherland Dr, Toronto, ON M4G 3V9, Canada"},{"name":"Faculty of Medicine, University of Toronto, Medical Sciences Building, 1 King\u2019s College Cir, Toronto, ON M5S 1A8, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1929-5067","authenticated-orcid":false,"given":"Christopher M.","family":"Cirnigliaro","sequence":"additional","affiliation":[{"name":"Department of Veterans Affairs Rehabilitation, Research, and Development Service, Spinal Cord Damage Research Center, Bronx, NY 10468, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laura D.","family":"Carbone","sequence":"additional","affiliation":[{"name":"Department of Medicine: Rheumatology, Medical College of Georgia, Augusta University, 1120 15th St, Augusta, GA 30912, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5457-5043","authenticated-orcid":false,"given":"Philemon","family":"Tsang","sequence":"additional","affiliation":[{"name":"KITE Research Institute, 520 Sutherland Dr, Toronto, ON M4G 3V9, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Leslie R.","family":"Morse","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, University of Minnesota, 500 Harvard St SE, Minneapolis, MN 55455, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,6,8]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1419","DOI":"10.1002\/cphy.c130045","article-title":"Autonomic consequences of spinal cord injury","volume":"4","author":"Hou","year":"2014","journal-title":"Compr. 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