Association of #bisphosphonate therapy with incident lower extremity #fractures in persons with spinal cord injuries/disorders

To investigate the association between prescriptions for bisphosphonates, calcium/Vitamin D supplements, and receipt of DXA screening, and incident fracture risk in men and women with a spinal cord injury/disorder (SCI/D)..

There was no significant association between prescriptions for bisphosphonates and incident lower extremity fractures in men (OR 1.04, 95% CI: 0.62-1.77) or women (OR 1.02, 95% CI 0.28-3.75). In men, similar null associations were seen among those who were adherent to bisphosphonate therapy (OR 1.25, 95% CI: 0.73-2.16), were concomitant users of Vitamin D/calcium and a bisphosphonate (OR 1.05 95% CI: 0.57-1.96), had more than one fracture on different dates during the study period (OR 0.13, 95% CI: 0.02-1.16) and in those who had undergone dual-energy x-ray absorptiometry (DXA) testing prior to the date of the bisphosphonate prescription and incident fracture (OR 1.26, 95% CI: 0.69-2.32).


In men with a traumatic SCI and women with a traumatic SCI or disorder, bisphosphonate therapies for osteoporosis do not appear to significantly impact fracture risk. Adequately powered randomized clinical trials are needed to definitively demonstrate efficacy of bisphosphonates for fracture prevention in this population. There is a compelling need to identify new medications to prevent fractures in this high-risk population.