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Osteoporosis Complications From Spine Injuries

Osteoporosis complications can occur after a spinal cord injury when bone tissue builds outside of the skeleton.

Bone building minerals and vitamins used to prevent osteoporosis are essential for building healthy bones.

People who have had a spinal cord injury may suffer from a condition called heterotopic ossification-a process by which bone tissue forms outside of the skeleton.

Heterotopic ossification following a spinal cord injury typically reveals itself on a radiograph 1 to 4 months after an injury-below the level of injury and usually at major joints. The overall incidence is about 40% and about one-half of these cases are clinically significant.

Both Canada and the U.S. have approved the drug Didronel® for osteoporosis complications resulting from spinal injuries. Didronel, which is produced by Proctor and Gamble (Didrocal® if supplemented with calcium carbonate) is also known as Etidronate in its generic form. Didronel therapy should begin as soon as medically feasible following an injury, preferably prior to evidence of heterotopic ossification. Retreatment has not been studied.


In 2007, Proctor and Gamble recommended the following treatment regime for heterotopic ossification:

  • 20 mg/kg/day for 2 weeks followed by 10 mg/kg/day for 10 weeks (12 weeks total)

Didronel is taken by mouth on an empty stomach two hours before meals. To maximize absorption, patients should avoid taking the following items within two hours of taking the medication:

  • Food – especially foods high in calcium, such as milk or milk products.
  • Vitamins with mineral supplements or antacids which are high in calcium, iron, magnesium, or aluminum.

If stomach upset occurs, it may be relieved somewhat by taking divided doses during the day instead of one daily dose.


In addition to any medication that is taken, it is important that spinal injury patients address osteoporosis complications through bone building minerals and vitamins in their diet and supplements. This is especially true for people who are taking bisphosphonate medications such as Didronel.

Once patients have recovered sufficiently from their injuries, it is also important to resume an appropriate level of exercise under the direction of a doctor or physiotherapist. Reliance on medication alone is discouraged. The Lower Back Toolkit provides excellent guidance on how to strengthen your back and relieve unnecessary pain.

To learn about calcium and vitamin supplements that help prevent osteoporosis complications... visit Osteoporosis Treatment Guidelines.