Spinal cord injury providers’ perspectives on managing sublesional osteoporosis

Abstract

Objective: Persons with spinal cord injuries (SCI) experience rapid sublesional bone loss following injury (1, 3). Evidence on preventing/managing osteoporosis in SCI is lacking. This project examined how providers manage bone loss in SCI.

Design: Telephone interviews with SCI providers.

Setting: VA SCI centers and clinics.

Participants: Veterans Administration SCI centers and clinics were categorized on their average number of dual-energy X-ray absorptiometry (DXA) scans (FY2014-2016). Twelve SCI providers from high and low DXA-ordering sites were interviewed. Questions included osteoporosis screening/diagnosis, prevention/treatment strategies, secondary causes of osteoporosis, and osteoporotic fracture complications. Interviews were audio-recorded, transcribed, and analyzed.

Results: Providers described a lack of standardized guidelines for managing osteoporosis in SCI. They most often screened for osteoporosis using DXA when: (1) considering use of a new device or activity, (2) for patients with a history of fracture. Some providers assumed that non-ambulatory SCI patients already have osteoporosis so infrequently ordered DXAs. Assessment of secondary causes of osteoporosis was uncommon. Fracture prevention strategies identified included weight-bearing and engaging in activities like adaptive sports. Vitamin D and calcium were frequently prescribed as a result of deficiencies identified during lab testing. Providers seldom prescribed FDA-approved medications for osteoporosis. Post-fracture complications encountered included nonunion/malunion and compartment syndrome. Providers indicated that patients often experienced psychological stress, anxiety and depression following fractures.

Conclusion: Providers described a lack of evidence for screening and management of patients with SCI and osteoporosis. Future efforts should include developing evidence-informed guidelines to aid providers in osteoporosis management.

Keywords:

• Spinal cord injury
• Osteoporosis
• DXA

Acknowledgements

This study was funded by the Department of Defense. The views expressed in this article are those of the authors and do not necessarily represent the views of the Departments of Defense or Veterans Affairs or the US government.

Disclaimer statements

Contributors None.

Conflicts of interest Authors have no conflict of interests to declare.

Additional information

Funding

This work was supported by the Department of Defense CMDRP program [SCI50092] and the Department of Veterans Affairs, Health Research & Development program [IIR15-294].