Risk of fracture among patients with spinal cord injury: A nationwide cohort study in South Korea

Background Clinical concerns about preventing and managing fractures after spinal cord injury (SCI) have been growing. Objective This study investigates the risk of fractures among SCI patients according to the presence of disability, disease severity, and level of injury. Methods We performed a retrospective cohort study using the Korean National Health Insurance Service (KNHIS 2010–2018) database. We included 5190 SCI patients and 1:3 age- and sex-matched control participants. The primary outcome was fracture, and the cohort was followed until December 31, 2019. Results SCI patients had a higher fracture risk than the matched controls (adjusted hazard ratio [aHR] 1.33, 95 % CI 1.16–1.54). The risk of fracture was higher in the presence of disability (aHR 1.57, 95 % CI 1.19–2.07), especially among patients with severe disability (aHR 1.65, 95 % CI 1.05–2.60). Higher fracture risks were observed among SCI patients regardless of injury level, but statistical significance was found only with cervical-level injury. When we considered site-specific fractures, vertebral (aHR 1.31, 95 % CI 1.04–1.64) and hip fracture risks (aHR 2.04, 95 % CI 1.39–2.98) were both higher among SCI patients than the controls. SCI patients with disability and cervical-level injury showed the highest hip fracture risk (aHR 3.67, 95 % CI 1.90–7.07). Conclusions Compared with the controls, SCI patients were at higher risk of any fracture, particularly hip fracture, especially those with disability and cervical-level injury. Clinicians should be aware of the fracture risk among SCI patients to provide proper management.