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Spinal cord injury providers' perspectives on managing sublesional osteoporosis.
The Journal of Spinal Cord Medicine ( IF 1.7 ) Pub Date : 2019-12-20 , DOI: 10.1080/10790268.2019.1704552
Frances M Weaver 1, 2 , Bella Etingen 1 , Marylou Guihan 1 , Cara Ray 1 , Michael Priebe 3 , Stephen Burns 4, 5 , Laura Carbone 3, 6
Affiliation  

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.



中文翻译:

脊髓损伤提供者对治疗皮损骨质疏松症的看法。

目的:脊髓损伤 (SCI) 患者在受伤后会经历快速的病灶下骨丢失 (1, 3)。缺乏预防/管理 SCI 骨质疏松症的证据。该项目研究了提供者如何管理 SCI 中的骨质流失。

设计:与 SCI 提供者的电话访谈。

设置: VA SCI 中心和诊所。

参与者:退伍军人管理局 SCI 中心和诊所根据其双能 X 射线吸收测定 (DXA) 扫描的平均次数(2014-2016 财年)进行分类。来自高和低 DXA 订购站点的 12 位 SCI 供应商接受了采访。问题包括骨质疏松症筛查/诊断、预防/治疗策略、骨质疏松症的次要原因和骨质疏松性骨折并发症。访谈被录音、转录和分析。

结果:提供者描述了缺乏管理 SCI 骨质疏松症的标准化指南。在以下情况下,他们最常使用 DXA 筛查骨质疏松症:(1) 考虑使用新设备或活动,(2) 有骨折病史的患者。一些提供者认为非走动 SCI 患者已经患有骨质疏松症,因此很少订购 DXA。对骨质疏松症继发性原因的评估并不常见。确定的骨折预防策略包括负重和参与适应性运动等活动。由于在实验室测试中发现缺乏维生素 D 和钙,因此经常开出维生素 D 和钙的处方。提供者很少为骨质疏松症开出 FDA 批准的药物。遇到的骨折后并发症包括骨不连/畸形愈合和骨筋膜室综合征。

结论:提供者描述了缺乏筛查和管理 SCI 和骨质疏松症患者的证据。未来的努力应包括制定循证指南,以帮助提供者进行骨质疏松症管理。

更新日期:2019-12-20
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