Sixty men with
spinal cord injury who had developed
pressure ulcers in the past but whose skin was intact when they joined the study were followed for 2 years, or until a
pressure ulcer developed. Forty of the men were contacted every 4-6 weeks to answer questions about their
skin care practices and to provide a 24 hour urine sample. The others were only contacted at the beginning and the end of the study to answer a questionnaire and to provide a urine sample. Changes in skin
collagen metabolism were monitored by measuring urinary excretion of a metabolite, glucosyl-galactosyl
hydroxylysine (glu-
gal Hyl), corrected for
creatinine excretion. Sustained increases in levels of glu-
gal Hyl excretion were detected at least 2 months and as much as 5 months in advance of overt clinical signs of
ulcer development. Increased excretion of glu-
gal Hyl was significantly associated (p < 0.05) with the development of a
pressure ulcer. An increase in the urinary excretion of glu-
gal Hyl is an indication of increased degradation of skin
collagen. Body mass index (weight/height2) of 33% of subjects with
pressure ulcers, and 12% of those without, was at least one standard deviation below the mean of all subjects. Thirty-six percent of those who smoked developed
ulcers, while only 26% of the nonsmokers did.(ABSTRACT TRUNCATED AT 250 WORDS)