Low hip and knee region bone mineral density (BMD) after spinal cord injury (SCI) results in an increased risk of lower extremity fragility fractures or sublesional osteoporosis (SLOP). There are currently no guidelines for the identification and treatment of SLOP among patients with chronic SCI. A paradigm for identification (medical screening, fracture risk, and bone mineral density assessment) of persons with SLOP who warrant treatment and selection of appropriate SLOP treatment(s) (lifestyle/nutrition modifications, bisphosphonate/rehabilitation therapies) is proposed. Content is based on the authors’ opinions/expertise and available published and unpublished literature and is intended for use by rehabilitation professionals.

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