Osteoporosis Awareness in Chronic Spinal Cord Injury

Overview

Osteoporosis is a common and serious complication of spinal cord injury (SCI), substantially increasing the risk of fragility fractures. Despite this elevated risk, awareness of osteoporosis among individuals living with SCI is not well understood. This cross-sectional observational study assessed the level of osteoporosis awareness in adults with chronic traumatic SCI and examined which demographic, injury-related, and healthcare-related factors were independently associated with awareness. Ninety-four adults with chronic traumatic SCI completed the Turkish version of the Osteoporosis Awareness Scale, along with a structured questionnaire covering education, injury characteristics, healthcare utilization, and personal health-seeking behaviors. The study aimed to identify modifiable factors linked to higher awareness in order to inform future educational interventions and improve osteoporosis prevention and management in this high-risk population.

Background: Individuals with spinal cord injury (SCI) experience rapid and severe sublesional bone loss, with fracture rates several-fold higher than in the general population. Patient awareness is an important determinant of preventive behavior, screening participation, and treatment adherence, yet the factors shaping osteoporosis awareness in the SCI population have not been systematically investigated, and no such data exist for the Turkish SCI population. Objectives: The study aimed to (1) assess osteoporosis awareness among individuals with chronic SCI using a validated instrument; (2) examine bivariate associations between potential predictors and awareness; and (3) identify factors independently associated with awareness through multivariable regression. Design and Setting: This was a single-center, cross-sectional observational study conducted at a tertiary physical medicine and rehabilitation center between January and December 2023. Participants: Ninety-four adults with documented traumatic SCI of at least 12 months' duration were enrolled through consecutive sampling. Individuals with significant cognitive impairment, acute illness requiring hospitalization, or inability to complete questionnaires in Turkish were excluded. Only traumatic SCI cases were included. Measures: Osteoporosis awareness was assessed using the Turkish version of the Osteoporosis Awareness Scale (31 items; total score range 31 to 124). Additional data included age, sex, education level, injury level and completeness, ASIA Impairment Scale grade, injury duration, fracture history, regular follow-up, receipt of osteoporosis education, personal research, bone density testing history, and use of bone-relevant medications. Statistical Analysis: Bivariate analyses used t-tests, one-way ANOVA, and correlation coefficients, with effect sizes reported. Multiple linear regression with nine predictors identified factors independently associated with awareness. Regression diagnostics and a sensitivity analysis were performed to confirm robustness.