Background: Spinal cord injury (SCI) can lead to serious complications, including bone loss and fragility fractures, making it important for radiologists to understand the frequencies and risk factors associated with these complications. Purpose: To describe the frequencies of bone mineral density (BMD) changes and fragility fractures after SCI in participants who underwent dual-energy X-ray absorptiometry (DXA). Materials and Methods: A retrospective chart review in a single rehabilitation center between December 2019 and August 2021 of participants with SCI who underwent DXA. Participants were divided into groups based on traumatic SCI, nontraumatic SCI, and simultaneous brain and SCIs. Within each group, participants were classified based on the presence or absence of fragility fractures and the results of BMD measurements. DXA measurements were assessed following the norms of the International Society of Clinical Densitometry. The knee BMD measurements followed the Toronto protocol. Blinded and independent evaluations were performed, and statistical analysis was performed using Fisher’s exact test. Results: Of a total of 358 participants with SCI (mean age 41 years +/- 15.4 [standard deviation]; 221 men), 263/358 (73.5%) had traumatic SCI, 68/358 (19.0%) had nontraumatic SCI, and 27/358 (7.5%) had simultaneous brain and SCIs. Osteoporosis was identified in 81/358 (22.6%) participants, with the highest rate seen in those with nontraumatic SCI (28/68, 41.2%). Fragility fractures were observed in 46/358 (12.9%), with the highest rate seen in those with nontraumatic SCI (14/68, 20.6%). There was a statistically significant association between fragility fractures and osteoporosis in participants with SCI (p=0.005, OR=3.9, 95% CI: 1.4-12.7). Conclusion: Almost one in five participants with SCI had osteoporosis, and more than one in 10 had fragility fractures. Nontraumatic SCI was associated with higher rates of osteoporosis and fragility fractures. Our study highlights the importance of monitoring bone health in SCI patients, particularly those with nontraumatic SCI.