VA-Based Survey of Osteoporosis Management in Spinal Cord Injury

PM R, 2009 · DOI: 10.1016/j.pmrj.2008.10.008 · Published: March 1, 2009

Spinal Cord Injury Healthcare Musculoskeletal Medicine

Simple Explanation

This study investigates how osteoporosis is managed in veterans with spinal cord injuries (SCI) within the VA healthcare system. There are no established guidelines for diagnosing, preventing, or treating osteoporosis in SCI patients, leading to potential inconsistencies in care. An online survey was conducted among VA healthcare providers to understand their current practices in diagnosing and treating osteoporosis in SCI patients. The survey explored demographics, diagnostic approaches, and treatment choices. The results showed that while many providers actively diagnose and treat osteoporosis in SCI patients, there is significant variation in their approaches. This suggests a need for evidence-based guidelines to standardize and improve care for this specific population.

Study Duration

Not specified

Participants

450 VHA National SCI Staff Physicians and VHA National SCI Nurses

Evidence Level

Level IV, Online Survey

Key Findings

1
More than half of the respondents (54%) actively prescribe medications for SCI-induced bone loss, with bisphosphonates and vitamin D being the most common choices.
2
A significant proportion of respondents (59%) routinely order diagnostic tests, including DEXA scans, to evaluate bone health in SCI patients.
3
Variations in diagnostic and treatment practices were not associated with factors like age, gender, or years of experience in SCI medicine, highlighting the lack of standardized protocols.

Research Summary

The study aimed to characterize osteoporosis management practices in SCI patients within the VA healthcare system due to the absence of established guidelines. A web-based survey was distributed to VHA National SCI Staff Physicians and Nurses to gather data on demographics, diagnostics, and treatment options. The findings revealed variations in practice, with over half of the respondents actively diagnosing and treating osteoporosis despite the lack of guidelines, suggesting a need for evidence-based protocols.

Practical Implications

Guideline Development

The study highlights the necessity for developing evidence-based guidelines for screening and treatment of osteoporosis in SCI patients to standardize care and reduce practice variations.

Improved Diagnostic Protocols

There is a need to improve diagnostic protocols, particularly DEXA scanning techniques, to accurately assess bone health at clinically relevant sites in SCI patients (e.g., knee).

Further Research

Further research is needed to determine the efficacy of different treatment strategies, including pharmacological and rehabilitation therapies, in preventing bone loss and reducing fracture rates in SCI patients.

Study Limitations

1
Relatively small sample size with a low response rate.
2
Restricted population of SCI providers within the VA medical system, potentially limiting generalizability.
3
Potential bias in the data as responders may be inherently more interested in treating SCI-induced osteoporosis.

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