Inactivity and obesity may explain the high cardiovascular morbidity in paraplegic (P) subjects. Total and segmental body composition, and maximal aerobic power (VO2max) were assessed in 13 P males (18-45 yrs, lesion levels lower than T5; BW 84±15 kg; BMI 25.7±4.3 kg/m2) and in 13 able-bodied matched controls (C). Fat body mass (FM) by 4-skinfold thickness method, and total and segmental body fat mass, fat free mass (FFM) and bone mineral density (BMD) were measured by DXA. DXA FM was 31.1±8.3% (SD) in P and 20.8±6.9% in C; FFM 51.4±6.3 and 56.2±5.6%, BMD 1.2±0.1 and 1.3±0.1 g/cm2, respectively. Segmental FM is higher (p<0.05) in P than in C, especially in lower limbs (37.3±10.3 vs 20.5±5.2%) and trunk (31.2±8.2 vs 22.3±8.0%). BMD is significantly lower in P in legs only (1.1±0.2 vs 1.5±0.2 g/cm2). Compared with DXA, the skinfold method underestimates FM in P patients (19.6±4.2 vs 22.3±6.8%). VO2max is about halved in P (18.0±6.3 vs 34.0±7.0 ml/kg/min), and a linear negative relationship (r=0.52, p<0.05) between FM and VO2max occurs. In conclusion, in P subjects the changes in total body composition, especially at sublesional level, and the dramatic decrease of aerobic power may represent a high risk for cardiovascular disease. Disagreement between DXA and skinfold method suggests to develop skinfold prediction equations specific to the P subjects. Supported by Ministry of Health and University.