Spinal cord injury providers’ perspectives on managing sublesional osteoporosis

Following a spinal cord injury (SCI), individuals often experience a rapid decrease in bone density below the level of injury, leading to osteopenia or osteoporosis. Current guidelines primarily address osteoporosis in postmenopausal women and older men, but there is a lack of specific guidance for managing bone loss in individuals with SCI. This study aimed to understand how healthcare providers manage bone health in their SCI patients, especially given the absence of condition-specific guidelines. The study involved interviewing providers from Veterans Affairs (VA) SCI centers and clinics about their screening, prevention, and treatment strategies for osteoporosis in SCI patients. The interviews revealed that providers often feel limited in their ability to address osteoporosis in SCI patients due to a lack of clear guidelines and effective treatment options. They tend to rely on physical activity, supplements like Vitamin D, and monitoring bone density with DXA scans, particularly when patients are considering new activities or devices.

• 1
  There is a lack of standardized guidelines for managing osteoporosis in SCI, leading to variability in screening and treatment approaches among providers.
• 2
  Providers primarily screen for osteoporosis using DXA scans when patients are considering new devices or activities, or after a fracture has occurred.
• 3
  FDA-approved medications for osteoporosis are seldom prescribed for SCI patients, with providers citing concerns about their effectiveness and potential side effects in this population.