1. This article and any supplementary material should be cited as follows: Lichy AM, Groah S. Asymmetric lower-limb bone loss after spinal cord injury: Case report. J Rehabil Res Dev. 2012;49(2):221–26. http://dx.doi.org/10.1682/JRRD.2011.03.0048 Slideshow Project DOI:10.1682/JRRD.2011.03.0048JSP Asymmetric lower-limb bone loss after spinal cord injury: Case report Alison M. Lichy, PT, DPT, NCS; Suzanne Groah, MD, MPH

2. This article and any supplementary material should be cited as follows: Lichy AM, Groah S. Asymmetric lower-limb bone loss after spinal cord injury: Case report. J Rehabil Res Dev. 2012;49(2):221–26. http://dx.doi.org/10.1682/JRRD.2011.03.0048 Slideshow Project DOI:10.1682/JRRD.2011.03.0048JSP Aim – Describe case of ambulatory male with motor incomplete spinal cord injury (SCI) and asymmetric lower-limb osteoporosis. – Determine relationships among bone mineral density (BMD), motor function, and gait pattern. Relevance – Osteoporosis occurs rapidly after acute SCI, with nearly 1/3 of bone loss occurring within 4 months after injury and continuing over next several years.

3. This article and any supplementary material should be cited as follows: Lichy AM, Groah S. Asymmetric lower-limb bone loss after spinal cord injury: Case report. J Rehabil Res Dev. 2012;49(2):221–26. http://dx.doi.org/10.1682/JRRD.2011.03.0048 Slideshow Project DOI:10.1682/JRRD.2011.03.0048JSP Methods – 32 yr old Caucasian male injured in work-related fall: Initial T4 American Spinal Injury Association Impairment Scale (AIS) “A.” 3 mo robotic body-weight-supported treadmill training 3 times/wk. – Outcome measures at 11 wk (baseline), 5 mo, and 1.5 yr postinjury: AIS examination. Walking Index for Spinal Cord Injury Version 2 (WISCI-II). BMD via dual-energy X-ray absorptiometry (DXA). Weight-bearing analysis (1.5 yr follow-up only).

4. This article and any supplementary material should be cited as follows: Lichy AM, Groah S. Asymmetric lower-limb bone loss after spinal cord injury: Case report. J Rehabil Res Dev. 2012;49(2):221–26. http://dx.doi.org/10.1682/JRRD.2011.03.0048 Slideshow Project DOI:10.1682/JRRD.2011.03.0048JSP Results AIS motor scores: – No change on right – Hip flexion strength of left improved. BMD decreased: – Lumbar spine 2.77% loss – Right proximal femur 3.96% loss – Left proximal femur 10.52% loss WISCI-II scores increased: – Baseline = 6 Ambulating with rolling- walker, left orthosis, and 1-person assistance. – 5 mo = 10 Ambulating with rolling- walker. – 1.5 yr = 19 Ambulating independently with single-point cane.

5. This article and any supplementary material should be cited as follows: Lichy AM, Groah S. Asymmetric lower-limb bone loss after spinal cord injury: Case report. J Rehabil Res Dev. 2012;49(2):221–26. http://dx.doi.org/10.1682/JRRD.2011.03.0048 Slideshow Project DOI:10.1682/JRRD.2011.03.0048JSP Results At 1.5 yr postinjury, additional DXA measurements at distal femur and proximal tibia revealed higher BMD in patient’s right vs left lower limb.

6. This article and any supplementary material should be cited as follows: Lichy AM, Groah S. Asymmetric lower-limb bone loss after spinal cord injury: Case report. J Rehabil Res Dev. 2012;49(2):221–26. http://dx.doi.org/10.1682/JRRD.2011.03.0048 Slideshow Project DOI:10.1682/JRRD.2011.03.0048JSP Conclusions Patient's asymmetric lower-limb motor function and gait pattern may have combined to result in asymmetric BMD loss. This case demonstrates need for BMD monitoring even in ambulatory individuals with SCI: – May benefit from treatment to reduce BMD loss and avoid fractures.