Background: Patients with SCI show mostly osteopenia or osteoporosis of the hip and spine. Vitamin D deficiency and secondary hyperparathyroidism may contribute to development of osteoporosis in SCI cases.

Method: A correlation study was conducted on 100 chronic SCI patients admitted in the Department of Physical Medicine &Rehabilitation, Sawai Man Singh Medical College, Jaipur. After taking information regarding subject and his/her injury, blood samples were collected to investigated for routine biochemistry with serum PTH and serum 25(OH)D. DXA scan of hip and spine was also done. Correlation between 25(OH)D with DXA and with PTH was found by Pearson correlation. Correlation between PTH with DXA was also found by Pearson correlation.

Result: The study revealed that 55% patients had subnormal vitamin D (<20 ng/mL). Positive correlation was found between vitamin D & BMD which was found significant for hip T score but not for spine T score. Whereas negative correlation was found between parathyroid hormone (PTH) & BMD which was found significant with both hip and spine T score. Negative correlation was found between vitamin D & PTH, which was also found significant.

Conclusion: Vitamin D and PTH play important role in SCI cases. So, monitoring of Serum 25(OH)D levels, serum PTH & serum calcium and annual surveillance of bone mineral density is crucial among persons with chronic SCI to reduce progression of osteoporosis and minimize the risk for further fractures.

Keywords: 25 Hydroxy Vitamin D (25(OH)D), Dual Energy X-Ray Absorptiometry (DEA), PTH: Parathyroid Hormone (PTH), Bone Mineral Density (BMD).

1. Maimoun, I. C.ouret, J. Micallef, E. Peruchon, D. Mariano-Goulart, M. Rossi, J. Leroux and F. Ohanna, “ Use of bone biochemical markers with dual-energy X-Ray absorptiometry for early determination of bone loss in persons with SCI,” Metabolism, pp. 958-963, 2002
2. Harrison’s principle of internal medicine; 19^th edition p;2463-2464,2488, 2493,96e-8
3. Inanc Karapolat,U. Karapolat, Yesim Kirazli, Kazim Capaci, Yesim Akkoc and Kamil Kumanlioglu. Longitudinal study of bone loss in chronic spinal cord injury patients. J PhysTher Sci. 2015 May; 27(5): 1429–1433.Published online 2015 May 26. doi:  10.1589/jpts.27.1429
4. Abbas Norouzi Javidan,Hadis Sabour, Sahar Latifi, Farzad Shidfar, Mohammad Reza Vafa, Ramin Heshmat, Hasan Emami Razavi, Baghe rLarijani and Hamidreza Aghaei Meybodi. Evaluation of bone mineral loss in patients with chronic traumatic spinal cord injury in Iran J Spinal Cord Med. November, 2014; 37(6): 744–750
5. Abbas Norouzi Javidan,Hadis Sabour, Sahar Latifi, Mohammadreza Vafa, Farzad Shidfar, Zahra Khazaeipour, Fatemeh Shahbazi, Abbas Rahimi, Seyed-Hassan Emami Razavi. Calcium and vitamin D plasma concentration and nutritional intake status in patients with chronic spinal cord injury: A referral centerreport  J Res Med Sci. 2014 Sep; 19(9): 881–884
6. Amina Chain, Josely C. Koury, Flávia Fioruci, Bezerra. Physical activity benefits bone density and bone-related hormones in adult men with cervical spinal cord injury ;September 2012,Volume 112, Issue 9, pp 3179–3186
7. Morse LR, Battaglino RA, Stolzmann KL, Hallett LD, Waddimba A, Gagnon D, et al. Osteoporotic fractures and hospitalization risk in chronic spinal cord injury.Osteoporos Int.2009 Mar;20(3):385–92
8. Jiang SD, Jiang LS, Dai LY. Mechanisms of osteoporosis in spinal cord injury.Clin Endocrinol (Oxf) 2006 Nov;65(5):555–65
9. Nemunaitis GA, Mejia M, Nagy JA, Johnson T, Chae J, Roach MJ. A descriptive study on vitamin D levels in individuals with spinal cord injury in an acute inpatient rehabilitation setting.PM R. Mar;2(3):202–8. quiz 28
10. Chen JS, Sambrook PN, March L, Cameron ID, Cumming RG, Simpson JM, Seibel MJ. Hypovitaminosis D and parathyroid hormone response in the elderly: effects on bone turnover and mortality.ClinEndocrinol (Oxf)2008 Feb;68(2):290–8
11. Determining Vitamin D Total (VitD) in Serum or Plasma using the ADVIA Centaur VitD assay on ADVIA Centaur and ADVIA Centaur XP Systems
12. Kusum Lata Gaur, Suresh C Soni, Rajeev Yadav. Comminity Medicine: Practical Guide. Second Edition. CBS publishers & Distributors Pvt. Ltd.:New Delhi India;2017.
13. Oleson C.V., Patel P.H., Wuermser L.A. Influence of season, ethnicity, and chronicity on vitamin D deficiency in traumatic spinal cord injury. Spinal Cord Med. 2010;33 (3):202–213
14. Irena Doubelt,Julia Totosy, Zepetnek, Maureen J. Mac Donald,Stephanie A, Atkinson. Influences of nutrition and adiposity on bone mineral density in individuals with chronic spinal cord injury. A cross-sectional, observational study Bone Rep. 2015 Jun; 2: 26–31.Published online 2015 Feb 18. doi:1016/j.bonr.2015.02.002
15. Arcangelo Barbonetti, Maria Rosaria, C. Vassallo, Giorgio Felzani, Sandro Francavilla, andFelice Francavilla. Association between 25(OH)-vitamin D and testosterone levels: Evidence from men with chronic spinal cord injury. J Spinal Cord Med. 2016 May; 39(3): 246–252
16. Bauman WA, Spungen AM. Metabolic changes in persons after spinal cord injury.Phys Med RehabilClin N Am. 2000;11:109–140
17. K Hummel BC, Giangregorio. serum 25(OH) D, PTH and correlates of suboptimal 25(OH)D levels in persons with chronic spinal cord injury spinal cord (2012) 50, 812-816
18. William A. Bauman, Racine R. Emmons, Christopher M. Cirnigliaro, Steven C. Kirshblum, Ann M. Spungen. An effective oral vitamin D replacement therapy in persons with spinal cord injury J Spinal Cord Med. 2011 Sep; 34(5): 455–460
19. Christina V. Oleson, MD, Benjamin J. Seidel, DO,Tingting Zhan, Association of vitamin D deficiency, secondary hyperparathyroidism, and heterotopic ossification in spinal cord injury; Journal of Rehabilitation Research & Development (JRRD)Volume 50 Number 9, 2013 Pages 1177 — 1186
20. Gaspar AP, Brandão CM, Lazaretti-Castro M.Bone mass and hormone analysis in patients with spinal cord injury: evidence for a gonadal axis disruption. J Clin Endocrinol Metab 2014;99(12):4649–55. doi: 10.1210/jc.2014-2165

Dr Rajeswari Jindal

20 Kailashpuri, Near Jagatpura Rly Station,

Malviyanagar Ext. Jaipur, PIN-302017, Rajasthan, India

Email: This email address is being protected from spambots. You need JavaScript enabled to view it., Mobile No. 09460271172