Background: Patients with neurological injury and neuromuscular disorders are at increased risk for osteoporosis and fragility fracture. This cross-sectional study investigated whether knee bone mineral density (BMD) correlates with fragility fracture in patients with neurological injury and neuromuscular injuries. Methodology: In this retrospective chart review, 435 participants underwent dual-energy X–ray absorptiometry (DXA) for BMD analysis. Distal femur and proximal tibial BMD measurements were performed as per the Toronto protocol. Spine, hip, and forearm DXA was performed following the standards of the International Society of Clinical Densitometry, 2019. Blinded and independent clinical evaluations and laboratory exams were performed. Participants were divided into groups with and without fracture confirmed by clinical history and radiography. Results: Distal femur and proximal tibial BMD were measured in 288/435 (66.2%) participants. Osteoporosis was noted in 138/288 (47.9%) patients. Fractures occurred in 95/435 participants (21.8%), including one fracture in 64/435 participants (14.7%), two fractures in 24/435 participants (5.5%), and greater than two fractures in 7/435 patients (1.6%). Fractures were noted in 23/54 (42.6%) participants with post-polio syndrome, 21/66 with brain injury (31.8%), 3/10 (30%) with brain injury and spinal cord injury, 24/98 (24.5%) with neuromuscular disorders, 9/52 (17.3%) with nontraumatic spinal cord injury, and 15/155 (9.7%) with traumatic spinal cord injury. The median BMD of the knee and hip was lower in participants with fractures. Distal femur and proximal tibial BMD (odds ratio [OR] = 0.02, 95% confidence interval [CI]: 0.01–0.45) remained independently associated with fragility fracture in multivariable analysis. Conclusion: Proximal tibial and distal femur BMD measurements offered additional information on neurological injury and neuromuscular disorders.

背景：患有神经损伤和神经肌肉疾病的患者患骨质疏松症和脆性骨折的风险增加。这项横断面研究调查了膝骨矿物质密度 (BMD) 是否与神经损伤和神经肌肉损伤患者的脆性骨折相关。方法：在这项回顾性图表审查中，435 名参与者接受了双能 X 射线吸收测定法 (DXA) 以进行 BMD 分析。股骨远端和胫骨近端 BMD 测量按照多伦多协议进行。脊柱、臀部和前臂 DXA 是按照国际临床密度测量学会 2019 年的标准进行的。进行了盲法和独立的临床评估和实验室检查。通过临床病史和影像学确认，将参与者分为有无骨折组。结果：288/435 (66.2%) 名参与者测量了股骨远端和胫骨近端的 BMD。138/288 (47.9%) 名患者出现骨质疏松症。95/435 名参与者 (21.8%) 发生骨折，其中 64/435 名参与者 (14.7%) 发生一次骨折，24/435 名参与者 (5.5%) 发生两次骨折，7/435 名患者发生两次以上骨折 (1.6%) ). 23/54 (42.6%) 的脊髓灰质炎后综合征参与者、21/66 的脑损伤参与者 (31.8%)、3/10 (30%) 的脑损伤和脊髓损伤参与者发生骨折, 24/98 (24.5%) 患有神经肌肉疾病，9/52 (17.3%) 患有非创伤性脊髓损伤，15/155 (9.7%) 患有创伤性脊髓损伤。骨折参与者的膝关节和髋关节 BMD 中值较低。在多变量分析中，股骨远端和胫骨近端 BMD（比值比 [OR] = 0.02，95% 置信区间 [CI]：0.01–0.45）仍然与脆性骨折独立相关。结论：胫骨近端和股骨远端 BMD 测量提供了有关神经损伤和神经肌肉疾病的更多信息。