OBJECTIVE: Although osteoporosis is common following spinal cord injury (SCI), no guidelines exist for its treatment, diagnosis, or prevention. The authors hypothesized that wide variations in diagnosis and treatment practices result from the absence of guidelines. This study sought to characterize the diagnosis and management practices within the VA health care system for osteoporosis following SCI. DESIGN: Online survey regarding osteoporosis management in SCI composed of 27 questions designed to gather information on responder demographics, osteoporosis diagnostics, and treatment options. SETTING: VA health care system. PARTICIPANTS: VHA National SCI Staff Physicians and VHA National SCI Nurses (total n = 450) were sent an email with an invitation to participate. INTERVENTION: Not applicable. MAIN OUTCOME MEASURES: Practice patterns were assessed, including factors associated with ordering a clinical workup and prescribing osteoporosis treatment. RESULTS: The response rate was 28%. Ninety-two prescribing practitioners (physicians, nurse practitioners, and physician assistants) were included in the analysis. Of these respondents, 50 (54%) prescribe medications for SCI-induced bone loss; 39 (42%) prescribe bisphosphonates and 46 (50%) prescribe vitamin D. There were 54 (59%) respondents who routinely order diagnostic tests, including dual energy x-ray absorptiometry scans in 50 (54%). Variations in practice were not explained by age, gender, or years practicing SCI medicine. Many respondents (23%) reported barriers to osteoporosis testing including lack of scanning protocols, cost, wheelchair inaccessibility of scanning facilities, and lack of effective treatment guidelines once osteoporosis is diagnosed. CONCLUSIONS: Despite an absence of screening and treatment guidelines, more than half of all respondents are actively diagnosing and treating osteoporosis with bisphosphonates within the VA health care setting. These data suggest that evidence-based practice guidelines are necessary to reduce practice variations and improve clinical care for this population.
OBJECTIVE: Although osteoporosis is common following spinal cord injury (SCI), no guidelines exist for its treatment, diagnosis, or prevention. The authors hypothesized that wide variations in diagnosis and treatment practices result from the absence of guidelines. This study sought to characterize the diagnosis and management practices within the VA health care system for osteoporosis following SCI. DESIGN: Online survey regarding osteoporosis management in SCI composed of 27 questions designed to gather information on responder demographics, osteoporosis diagnostics, and treatment options. SETTING:VA health care system. PARTICIPANTS: VHA National SCI Staff Physicians and VHA National SCI Nurses (total n = 450) were sent an email with an invitation to participate. INTERVENTION: Not applicable. MAIN OUTCOME MEASURES: Practice patterns were assessed, including factors associated with ordering a clinical workup and prescribing osteoporosis treatment. RESULTS: The response rate was 28%. Ninety-two prescribing practitioners (physicians, nurse practitioners, and physician assistants) were included in the analysis. Of these respondents, 50 (54%) prescribe medications for SCI-induced bone loss; 39 (42%) prescribe bisphosphonates and 46 (50%) prescribe vitamin D. There were 54 (59%) respondents who routinely order diagnostic tests, including dual energy x-ray absorptiometry scans in 50 (54%). Variations in practice were not explained by age, gender, or years practicing SCI medicine. Many respondents (23%) reported barriers to osteoporosis testing including lack of scanning protocols, cost, wheelchair inaccessibility of scanning facilities, and lack of effective treatment guidelines once osteoporosis is diagnosed. CONCLUSIONS: Despite an absence of screening and treatment guidelines, more than half of all respondents are actively diagnosing and treating osteoporosis with bisphosphonates within the VA health care setting. These data suggest that evidence-based practice guidelines are necessary to reduce practice variations and improve clinical care for this population.
Authors: N L Gilchrist; C M Frampton; R H Acland; M G Nicholls; R L March; P Maguire; A Heard; P Reilly; K Marshall Journal: J Clin Endocrinol Metab Date: 2007-01-16 Impact factor: 5.958
Authors: L R Morse; R A Battaglino; K L Stolzmann; L D Hallett; A Waddimba; D Gagnon; A A Lazzari; E Garshick Journal: Osteoporos Int Date: 2008-06-26 Impact factor: 4.507
Authors: Leslie R Morse; Supreetha Sudhakar; Valery Danilack; Carlos Tun; Antonio Lazzari; David R Gagnon; Eric Garshick; Ricardo A Battaglino Journal: J Bone Miner Res Date: 2012-02 Impact factor: 6.741
Authors: Frances M Weaver; Brian Le; Cara Ray; Scott Miskevics; Beverly Gonzalez; Laura D Carbone Journal: J Spinal Cord Med Date: 2019-03-19 Impact factor: 1.985
Authors: L R Morse; S Sudhakar; A A Lazzari; C Tun; E Garshick; R Zafonte; R A Battaglino Journal: Osteoporos Int Date: 2012-07-17 Impact factor: 4.507
Authors: L R Morse; N Nguyen; R A Battaglino; A J Guarino; D R Gagnon; R Zafonte; E Garshick Journal: Osteoporos Int Date: 2016-07-13 Impact factor: 4.507
Authors: M Bethel; F M Weaver; L Bailey; S Miskevics; J N Svircev; S P Burns; H Hoenig; K Lyles; L D Carbone Journal: Osteoporos Int Date: 2016-05-26 Impact factor: 4.507
Authors: Aaron T Seaman; Melissa Steffen; Taisha Doo; Heather S Healy; Samantha L Solimeo Journal: J Gen Intern Med Date: 2018-07-27 Impact factor: 5.128