Introduction <p>Osteoporosis is a disease characterized by low bone mass and fracture of the bones irrespective of the aetiology. Insufficient data is available on the management of osteoporosis specific to individuals with spinal cord injury (SCI).</p> Case Report <p>The case describes a 24-year-old gentleman with a chronic spinal cord injury of 3-year duration, who was poorly evaluated and underwent unsupervised trial of therapeutic standing, resulting in a symmetrical supracondylar femoral fragility fracture. The assessment and management of the fractures and subsequent hemarthroses are also described in detail.</p> Discussion <p>Research shows mechanical loading of long bones in the lower extremity has the potential to reverse the osteoporotic process in SCI. However, ungraded and unsafe loading of joints following prolonged immobilization in individuals with chronic SCI, however may increase the risk of lower extremity fractures if appropriate measures for osteoporosis screening and treatment are not done.</p> Conclusion <p>This case report attempts to shine light on the need for proper evaluation to rule out osteoporosis prior to weight bearing or strenuous activity in this patient population, as well as the urgent need for timely mobilization and rehabilitation. Further research on weight bearing following chronic spinal cord injury is required to ascertain precise guidelines on timely loading of joints and prevent complications such as osteoporosis and fragility fractures. </p>