SCIBone loss after SCI is fast, common, and mostly silent — about 80% of people develop osteoporosis below their injury level. The result is bones that can break with surprisingly little force, sometimes without you feeling it. Here's what to know.
Why Bones Weaken
Bone stays strong by being loaded — through standing, walking, and muscle pull. After SCI those forces disappear below the injury, and the body rapidly removes bone it's no longer "using." Loss can begin within the first six months, and people commonly lose 30–40% of leg bone density in the first few years.
Fracture Risk
The fracture rate after SCI is roughly double the general population. The weak spots are around the knee — the lower thigh bone (femur) and upper shin (tibia). These "fragility fractures" can happen during everyday activities: a transfer, a range-of-motion stretch done too forcefully, a minor fall, or a leg caught against a doorway.
Spotting a Fracture You Can't Feel
Prevention & Treatment
- Vitamin D and calcium — ask your doctor to check your vitamin D level and supplement as needed.
- Medication — bisphosphonates (e.g., alendronate, zoledronic acid) slow bone loss; teriparatide can build bone. A doctor decides based on your bone-density scans.
- Weight-bearing / loading — standing programs, supported standing frames, and FES cycling apply force to bone and may help (see physical therapy and adaptive fitness).
- DEXA bone-density scans to monitor over time.
- Limit caffeine and alcohol, and don't smoke — all work against bone.
- Gentle technique — careful transfers and range of motion reduce fracture risk in fragile limbs.
What Nobody Tells You
- Bones break during ordinary moments. Most SCI fractures aren't dramatic falls — they're transfers, stretches, and bumps. Handle fragile legs gently.
- Swelling can mean a break, not just a clot. New leg swelling could be a fracture or a DVT — both need prompt evaluation.
- The loss starts immediately. Don't wait years to ask about vitamin D and a bone-density plan — the first months matter most.
- Standing and FES may pay off. Beyond bone, they help circulation, bladder, and spasticity — ask your team if they fit your program.
Sources & Further Reading
This page draws on lived SCI experience and published clinical guidance, including:
- Bone Loss After Spinal Cord Injury — Model Systems Knowledge Translation Center (MSKTC) (see the factsheet library)
- Osteoporosis — National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
- Spinal Cord Injuries — MedlinePlus (U.S. National Library of Medicine)
SCI.help articles are information, not medical advice. Practice varies by injury level, provider, and institution — always confirm specifics with your own care team.