Screenings after a spinal cord injury

Checks at a glance

Check	What the guidance says	Source
Blood pressure	At every routine visit and at least once a year	(SCI cardiometabolic guideline, 2018)
Diabetes and prediabetes	Screen adults; repeat at least every three years if normal	(SCI cardiometabolic guideline, 2018)
Cholesterol and triglycerides	At least every three years if normal; yearly with several risk factors	(SCI cardiometabolic guideline, 2018)
Weight (obesity)	From discharge from rehabilitation, then at least every three years if normal	(SCI cardiometabolic guideline, 2018)
Bone density (DXA)	As soon as medically stable, at the hip, lower thigh bone and upper shin bone	(Bone health guide, 2020)
Kidney ultrasound	Lifelong if at high risk; every year or every 2 years	(NICE CG148)
Bowel, breast and cervical cancer screening	Same recommendations as the general population	(Colorectal study, 2020) (Breast and cervical review, 2024)

Blood pressure, blood sugar and cholesterol

The 2018 guideline from the Consortium for Spinal Cord Medicine says people with a spinal cord injury are often less active, overweight and have abnormal blood fats, which raises their risk of heart disease and diabetes. It recommends measuring blood pressure at every routine visit and at least once a year, and confirming a high reading at a separate visit. It says posture and blood pressure swings from the injury make the diagnosis harder, and that in people with tetraplegia, high blood pressure lying down can be missed if only seated readings are taken. (SCI cardiometabolic guideline, 2018)

The same guideline recommends screening adults with a spinal cord injury for diabetes and prediabetes, using the American Diabetes Association tests (fasting glucose, a glucose tolerance test or A1C), and repeating the test at least every three years if it is normal. It recommends fasting LDL, total cholesterol, triglycerides and HDL at least every three years when first normal, and yearly with several risk factors. (SCI cardiometabolic guideline, 2018) See blood pressure readings: what they mean, A1C and blood sugar test results and cholesterol test by age.

Weight

The guideline recommends assessing obesity from discharge from rehabilitation. Because body mass index underestimates body fat after a spinal cord injury, it uses a body mass index of 22 or more as the marker of obesity and high risk, instead of the usual cutoff of 30. It recommends repeating the check at least every three years when normal. (SCI cardiometabolic guideline, 2018)

Bone density

A 2020 guide for primary care providers says people with a spinal cord injury are at high risk of osteoporosis, most bone loss happens in the first year after complete paralysis, and fractures happen most often around the knee. Citing the 2019 International Society for Clinical Densitometry position, it says all adults with a spinal cord injury causing permanent loss of movement or feeling should have a DXA scan of the total hip, lower thigh bone and upper shin bone as soon as they are medically stable. It says follow-up scans are done at 1 to 2 year intervals, on the same machine. (Bone health guide, 2020) See bone density test: how often and bone density test results.

Kidney and bladder follow-up tests

NICE recommends lifelong kidney ultrasound for people at high risk of kidney complications, and names people with a spinal cord injury among them. It suggests a scan every year or every 2 years, and says to consider bladder pressure tests (urodynamics) as part of follow-up. It says not to rely on creatinine and eGFR blood tests alone to monitor kidney function, and not to use plain X-rays, kidney scintigraphy or cystoscopy for routine follow-up. (NICE CG148)

NICE also says there may be a higher risk of bladder cancer, especially after many years of bladder problems and repeated urinary infections, and that blood in the urine is the main symptom to report. (NICE CG148) See kidney disease screening, kidney test results and bladder cancer screening.

Bowel, breast and cervical cancer screening

A 2020 study of 54,965 people in the US spinal cord injury database found colorectal cancer deaths were not higher overall than in the general population. It concluded that the current colorectal cancer screening recommendations should be continued while reducing barriers to care, and noted that bowel preparation for a colonoscopy can be hard after a spinal cord injury. (Colorectal study, 2020) See colorectal cancer screening tests compared.

A 2024 review found that breast and cervical screening recommendations for women with a spinal cord injury do not differ from those for the general population. Women with a spinal cord injury had 1.4 times the odds of not having a recent mammogram and 1.8 times the odds of not having a recent Pap test. The main barriers were clinics and equipment that were hard to access, such as exam tables and mammography machines, and providers' lack of knowledge about spinal cord injury. (Breast and cervical review, 2024) See mammogram: what to expect and cancer screenings by age.

When to contact a provider

MedlinePlus, spinal cord trauma, when to contact a medical professional: (MedlinePlus)

Contact your provider if you have a back or neck injury. Call 911 or the local emergency number if you lose movement or feeling. This is a medical emergency.

NICE says blood in the urine is a symptom to report to a health professional. (NICE CG148)

Where they differ:

Bone density. The USPSTF recommends screening women 65 and older, and younger postmenopausal women at higher risk. (USPSTF, 2025) The spinal cord injury guide recommends a scan for all adults with permanent loss of movement or feeling, at any age, at the hip and knee rather than the spine. (Bone health guide, 2020)
Diabetes. The USPSTF recommends screening adults aged 35 to 70 who have overweight or obesity. (USPSTF, 2021) The 2018 spinal cord injury guideline recommends screening adults with a spinal cord injury without an age or weight limit. (SCI cardiometabolic guideline, 2018)
Weight cutoff. The spinal cord injury guideline treats a body mass index of 22 or more as obesity, while the general definition starts at 30. (SCI cardiometabolic guideline, 2018)
Kidney tests. NICE sets kidney ultrasound as the routine follow-up test and advises against routine cystoscopy and against relying on blood tests alone. (NICE CG148)

Your doctor decides what your result means for you.

Questions people ask

Do cancer screening recommendations change after a spinal cord injury?

No. A 2024 review found that breast and cervical screening recommendations for women with a spinal cord injury do not differ from those for the general population, and a 2020 study concluded that the current colorectal cancer screening recommendations should be continued. Both found that people with a spinal cord injury are screened less often. (Breast and cervical review, 2024) (Colorectal study, 2020)

When should bone density be checked after a spinal cord injury?

A 2020 guide for primary care, based on the 2019 International Society for Clinical Densitometry position, says all adults with a spinal cord injury causing permanent loss of movement or feeling should have a DXA scan of the hip, lower thigh bone and upper shin bone as soon as they are medically stable. (Bone health guide, 2020)

How often are the kidneys checked after a spinal cord injury?

NICE recommends lifelong kidney ultrasound for people at high risk of kidney complications, including people with a spinal cord injury, and suggests a scan every year or every 2 years. (NICE CG148)

How often should blood sugar and cholesterol be tested?

The 2018 spinal cord injury guideline recommends screening adults for diabetes and prediabetes and repeating the test at least every three years if it is normal, and testing cholesterol and triglycerides at least every three years, or every year with several risk factors. (SCI cardiometabolic guideline, 2018)

Is blood pressure measured differently after a spinal cord injury?

The 2018 guideline recommends measuring blood pressure at every routine visit and at least once a year, and says posture and swings in blood pressure can make readings harder to interpret. In people with tetraplegia, high blood pressure lying down can be missed if only seated readings are taken. (SCI cardiometabolic guideline, 2018)