Abstract
Study design
Survey.
Objectives
Managing osteoporosis in persons with chronic spinal cord injury (SCI) is difficult as little evidence exists regarding effective strategies. We examined the effect of key factors on providers’ bone health management decisions in persons with SCI.
Setting
USA.
Methods
Providers reviewed blocks of 9 hypothetical cases that varied on four factors: osteoporosis, osteopenia, or normal bone mineral density using dual-energy X-ray absorptiometry (DXA); DXA region of interest (lumbar spine, hip, knee), prior lower extremity fracture; and no or limited ambulation. They indicated how likely they would recommend pharmacological management, what treatment(s) they would recommend, and whether they would request another DXA before treatment.
Results
Eighty-two healthcare providers completed the survey. Treatment recommendations for bisphosphonates and Vitamin D/calcium supplements, respectively, were more likely if there was a prior fracture (OR: 2.65, 95%CI: 1.76–3.99, p < 0.0001; OR: 2.96, 95%CI: 1.40–6.26, p = 0.004) and if a DXA scan found osteopenia (OR: 2.23, 95%CI: 1.41–3.54, p = 0.001; OR: 6.56, 95%CI: 2.71–15.85, p < 0.0001) or osteoporosis (OR: 12.08, 95%CI: 7.09–20.57, p < 0.0001; OR: 4.54, 95%CI: 2.08–9.90, p < 0.0001). Another DXA scan was more likely to be requested if there was a prior fracture (OR: 1.75, 95%CI: 1.10–2.78, p = 0.02) but less likely if the person was nonambulatory (OR: 0.41, 95%: 0.19–0.90, p = 0.03).
Conclusions
Prior fracture and DXA findings influenced treatment recommendations for bone health management in SCI. Reliance on lumbar spine scans to determine bone loss and treatment identifies a knowledge gap for which future education is required.
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Acknowledgements
The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the U.S. Department of Defense, the U.S. Department of Veterans Affairs or the United States government. The data for this study were collected and managed using REDCap electronic data capture tools hosted at the VA. More information about REDCap can be found in the following articles: http://www.sciencedirect.com/science/article/pii/S1532046408001226 and https://www.sciencedirect.com/science/article/pii/S1532046419301261.
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Funding was provided by the United States Department of Defense grant # SCI W81xWH-16-1-0413.
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FMW was responsible for conceiving and designing the work, interpreting results, drafting manuscript, approval of final version, and agrees to be accountable for all aspects of the work. BG was responsible for interpreting the results, drafting manuscript, approval of final version, and agrees to be accountable for all aspects of the work. CR was responsible for data acquisition, interpreting results, revising the manuscript for important intellectual content, approval of final version, and agrees to be accountable for all aspects of the work. BE was responsible for interpreting results, revising the manuscript for important intellectual content, approval of final version, and agrees to be accountable for all aspects of the work. AS was responsible for designing the work, interpreting the results, revising the manuscript for important intellectual content, approval of final version, and agrees to be accountable for all aspects of the work. SB was responsible for designing the work, interpreting the results, revising the manuscript for important intellectual content, approval of final version, and agrees to be accountable for all aspects of the work. BL was responsible for data acquisition, interpreting the results, revising the manuscript for important intellectual content, approval of final version, and agrees to be accountable for all aspects of the work. HA was responsible for data acquisition, interpreting the results, revising the manuscript for important intellectual content, approval of final version, and agrees to be accountable for all aspects of the work. MP was responsible for designing the work, interpreting the results, revising the manuscript for important intellectual content, approval of final version, and agrees to be accountable for all aspects of the work. LDC was responsible conceiving and designing the work, interpreting results, revising the manuscript for important intellectual content, approval of final version, and agrees to be accountable for all aspects of the work.
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Weaver, F.M., Gonzalez, B., Ray, C. et al. Factors influencing providers’ decisions on management of bone health in people with spinal cord injury. Spinal Cord 59, 787–795 (2021). https://doi.org/10.1038/s41393-020-00589-y
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DOI: https://doi.org/10.1038/s41393-020-00589-y
