A study of bone mineral density in adults with disability.

OBJECTIVES: To examine prevalence of low bone mineral density (BMD) among adults with disability, using World Health Organization diagnostic categories. DESIGN: Cross-sectional study. SETTING: National Rehabilitation Hospital, Dublin, Ireland. PARTICIPANTS: Patients (N=255; 178 men, 77 women) who were disabled for at least 3 months because of acquired brain injury, spinal cord injury, other neurologic condition, or lower-limb amputation. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Laboratory investigations including intact parathyroid hormone, 25-hydroxyvitamin D (25-OHD), and sex hormones; and BMD of lumbar spine and at least 1 hip, measured by dual-energy x-ray absorptiometry and expressed as T scores and z scores. RESULTS: Mean age +/- SD of participants was 48.7+/-15.6 years. Vitamin D deficiency, 25-OHD level 50 nmol/L or less, occurred in 154 (62.9%); insufficiency, a level between 51 and 72 nmol/L, occurred in 36 (14.7%). Based on T scores, 108 participants (42.4%) had osteopenia, and 60 (23.5%) had osteoporosis. A z score of -1 or less but more than -2 occurred in 76 (29.8%); a further 52 (20.4%) had a z score of -2 or less. On multiple linear regression analysis, ambulatory status and duration of disability were independent predictors of BMD at neck of femur (beta=.152, P=.007; beta=-.191, P=.001, respectively) and total proximal femur (beta=.170, P=.001; beta=-.216, P<.001, respectively). CONCLUSIONS: Osteopenia and osteoporosis are very common in adults with disability participating in rehabilitation, compared with the general young adult population. Duration since onset of disability and mobility status are independent predictors of BMD at the hip. Bone health monitoring should form part of the long-term follow-up in adults with newly acquired disabilities.

Post-traumatic syringomyelia: a review of the cases presenting in a regional spinal injuries unit in the north east of England over a 5-year period.

STUDY DESIGN: Retrospective study of the management of patients with a confirmed diagnosis of post-traumatic syringomyelia (PTS) in a regional spinal injuries unit. OBJECTIVES: To investigate the incidence of PTS in a regional spinal injuries unit, and to assess mode of presentation, management, and subsequent outcome. SUMMARY OF BACKGROUND DATA: Majority of patients male, mean age 44 years (range 33-60 years), with thoracic spinal cord injury (SCI). Most PTS developed within 5 years after injury (range 6 months to 25 years) and presented with reduced sensation. Fifty percent had surgical intervention at the time of SCI, and 50% managed conservatively. Four patients had additional spinal injury pathology not corrected at time of surgery. METHODS: Retrospective analysis of the case notes of all patients with a confirmed diagnosis of PTS (n = 16). Demographic details obtained and details of the original injury and subsequent clinical course and management noted. RESULTS: Incidence of PTS = 0.02%. Magnetic resonance imaging scanning performed in 56% with PTS. The majority of PTS developed around the site of the original lesion. The most common method of management was insertion of a syringoperitoneal shunt (44%). Thirty-one percent improved after surgery, 31% remain stable. One patient died. The symptoms of 3 patients continue to deteriorate slowly despite surgical intervention. CONCLUSIONS: Incidence of PTS are lower in our study than that quoted in the literature. Benefits of initial surgical management of SCI in reducing development of PTS are unclear. Benefits of surgical management of PTS are unclear. Additional studies are required as this may influence future management of spinal cord injured patients.