A pulse survey: assessment and management of bone loss in spinal cord injury

Spinal Cord Series and Cases, 2021 · DOI: https://doi.org/10.1038/s41394-020-00361-7 · Published: January 1, 2021

Spinal Cord Injury Musculoskeletal Medicine

Simple Explanation

This study is about how doctors assess and treat bone loss in people with spinal cord injuries (SCI). The researchers wanted to see if the treatments used match what experts recommend. The study found that there's a lot of variation in how doctors screen for bone loss, what tests they use, and how they treat it. This suggests that doctors aren't always following the recommended guidelines. The researchers suggest that there is a need to better share and use existing guidelines to improve the detection and treatment of osteoporosis in SCI.

Study Duration

April to December 2019

Participants

82 professionals working in SCI Medicine

Evidence Level

Not specified

Key Findings

1
Professionals were equally likely to test for bone loss during the post-acute phase (between 4- and 18-months post injury) and after low impact fracture (41.46% and 42.68%, respectively) and more likely to test during the chronic phase (51.22%).
2
The majority of respondents (n = 56, 70%) assessed bone density with DXA at the hip, and many (48.78%, n = 40) prescribed simultaneous mobilization, vitamin D and calcium to prevent bone loss in the acute, post-acute and chronic phases.
3
A number of evaluations and interventions were inconsistent with best practice recommendations.

Research Summary

The study assessed clinical practice patterns regarding osteoporosis assessment and management in an international cohort of SCI professionals and compared them to those advanced by professional societies. The survey identified a lack of consistency in the clinical approach to osteoporosis screening, bone density testing protocols, interpretation of bone density results, and interventions to mitigate bone loss in acute or chronic SCI. The responses suggest a lack of standard practices internationally and support ongoing dissemination efforts of recently established clinical guidelines as well as additional clinical trials to determine intervention efficacy.

Practical Implications

Guideline Dissemination

There is a need for wider dissemination and adoption of existing clinical practice guidelines for osteoporosis management in SCI.

Standardization of Practices

Efforts should be made to standardize practices related to osteoporosis screening, bone density testing, and treatment interventions in SCI.

Further Research

Additional clinical trials are needed to determine the efficacy of various interventions for both prophylaxis of bone loss and treatment of osteoporosis after SCI.

Study Limitations

1
Low response rate.
2
The survey is not representative of some regions with poor response rates from ASIA and Africa.
3
The responses are self-reported and we cannot confirm actual prescribing practices.

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