Effects of drugs on bone metabolism in a cohort of individuals with traumatic spinal cord injury

Study Design: This study is a retrospective review examining the prevalence of drugs commonly used in the management of spinal cord injury (SCI) which may influence bone health. Objective: The aim of our study was to examine the role commonly prescribed medications play in post-SCI bone health. Setting: We included all males 21 years of age and older who were evaluated over a 10-year period at an SCI-specialized center for a trauma-induced SCI. Method: We compared characteristics of individuals with normal bone mass to those with low bone mass according to their dual-energy X-ray absorptiometry (DXA) scan. Medication lists were reviewed for the presence of drugs considered to either positively or negatively affect bone metabolism. Results: Comparing individuals with normal bone mass (n = 68) to those with low bone mass (n = 211), only "Time after Injury" and "Level of Injury" were found to influence the likelihood of having low bone mass. Multivariate analysis failed to demonstrate significant associations between bone mass and the sum of drugs which either positively or negatively affect bone metabolism. When medications were reviewed individually, only bisphosphonates and anticonvulsants were found to be significantly associated with bone mass. Conclusions: Although 76% of our cohort was found to have low bone mass, the only major risk factors were "Time after Injury" and "Level of Injury". Anticonvulsant use was more common in individuals with low bone mass compared to those with normal bone mass. Given the retrospective methodology of this work, our findings underline associations that warrant further investigation.