Topics: Spinal Cord Injury, Complications, heterotopic ossification

Secondary SCI Conditions: Heterotopic Ossification (HO)

Out of all of the secondary conditions that can occur after a spinal cord injury, one of the lesser-known is Heterotopic Ossification (HO). Abnormal bone growth in the soft tissue around joints in the body, this condition occurs in one in five people with a spinal cord injury, which is around 20% of people with paralysis.  

While bone growth may seem benign, the bone growth stemming from Heterotopic ossification is painful. The bone growth grows quickly, up to 3x as fast as normal bone growth, and ends up rough and jagged. Among people with complete spinal cord injuries, one of the worst side effects of this condition isn’t the pain but the severely decreased range of motion where the HO is present.

Even though the true cause of Heterotopic Ossification remains a mystery to doctors, there are several treatments available that can help slow bone growth or stop it completely. From the symptoms of Heterotopic ossification to the treatments available, read on for a thorough overview of one of the most frustrating secondary conditions of having a spinal cord injury.

Symptoms of Heterotopic Ossification


After a spinal cord injury, Heterotopic Ossification can occur in the acute phase, typically in the first 2-3 months, or it can happen years after an injury. Men will more often have Heterotopic Ossification vs. females. Other injuries also cause Heterotopic Ossification such as brain injuries and multiple sclerosis. Your genetics may also play a part. Some doctors say that muscle spasms or simply having prolonged pressure on your hips can cause HO.

And for those who get Heterotopic Ossification, 90% will have bone growth in the hip area, which can limit the range of motion. Heterotopic Ossification can also occur in the knees, elbows, and shoulders. Also, if you are over age 40 and sustain a spinal cord injury, you're less likely to have the Heterotopic Ossification. More people in their 20s and 30s have HO than those who are older.

The first two unmistakable signs of Heterotopic Ossification are decreased range of motion and swelling, reddening and warm skin where the Heterotopic Ossification is present. This can happen quickly, with many people reporting a sudden swelling of the affected area. Here are other common symptoms of HO:

  • Increased spasticity in the muscles of the affected area.
  • If you have an incomplete injury, the pain will be present where the bone growth is occurring.
  • A fever can occur during the onset of Heterotopic Ossification and can be up to 103° degrees in some cases. 

Treatments Available for HO

female doctor checking results

Once you are officially diagnosed with HO by a blood test, CT scan, ultrasound or x-ray, your doctor will decide the best way to treat it. Warfarin is often prescribed to stop bone growth from HO, as is Etidronate, but the latter is only effective if given in the early onset phase of HO. If you have a new spinal cord injury and have no symptoms of HO, doctors will sometimes administer anti-inflammatory drugs, which can stop the onset of HO altogether.

Outside of medication, pulse low-intensity electromagnetic field therapy is used, also known as PEMF therapy, which can help improve the function of cells in the body and prevent HO. Radiation is also used to stop the progression of Heterotopic Ossification. And lastly, surgery can remove the bone growth from the soft tissue. 

While surgery can remove bone matter effectively, reduce pain and improve joint movement, blood loss is common during HO removal surgery. Also, surgery can cause HO to return at a later date. If surgery is performed, Pamidronate will be administered to prevent HO from returning.

It is best to seek treatment for HO. While treatments sometimes do not work for HO, they are worth pursuing to see if any treatment available can alleviate it. If not treated long-term, side-effects of HO include pressure sores from limited mobility, UTIs, pneumonia, stiff muscles and the inability to use certain mobility equipment, like sitting at in the desired position in a wheelchair.

Vincent Dolan

Written by Vincent Dolan

A the Director of Public Affairs at Vincent has had the opportunity to speak with thousands of individuals (and families) during every step of the recovery process. Vincent has combined his legal and marketing expertise to create the single largest resource for those impacted by a spinal cord or other catastrophic injury. While gathering and sharing these resources Vincent also spends time answering the hotline which allows him to better understand what families are going through. Vincent is actively involved in supporting various non profits within the SCI community, and is always open to helping in whatever way he can. Vincent also works with our sponsors Swope, Rodante P.A. to ensure families have every opportunity to obtain the resources which improve the quality of life for individuals after a spinal cord injury.

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