PM&R
Volume 1, Issue 3 , Pages 240-244, March 2009

VA-Based Survey of Osteoporosis Management in Spinal Cord Injury

  • Leslie R. Morse, DO

      Affiliations

    • Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA†
    • Corresponding Author InformationAddress correspondence to: L.R.M.; Department of PMR, Harvard Medical School, The Forsyth Institute, 140 The Fenway, Boston, MA 02118
    • ,
  • Lora Giangregorio, PhD

      Affiliations

    • Department of Kinesiology, University of Waterloo, Waterloo, Ontario, Canada‡
    • ,
  • Ricardo A. Battaglino, PhD

      Affiliations

    • Department of Cytokine Biology, Forsyth Institute, Boston, MA§
    • ,
  • Robert Holland, MD

      Affiliations

    • Staten Island University Hospital, Staten Island, NY
    • ,
  • B. Catharine Craven, MD

      Affiliations

    • Department of Medicine, Toronto Rehabilitation Institute, University of Toronto, Canada∥
    • ,
  • Kelly L. Stolzmann, MS

      Affiliations

    • Research and Development Service, Department of Veterans Affairs, VA Boston Healthcare System, Boston, MA and Programs in Research at VA Boston, Harvard Medical School, Boston, MA#
    • ,
  • Antonio A. Lazzari, MD, PhD, CCD

      Affiliations

    • Research and Development Service, Department of Veterans Affairs, VA Boston Healthcare System, Boston, MA, Division of Primary Care and Rheumatology Section, VA Boston Healthcare System, Boston, MA, and Boston University School of Medicine, Boston, MA⁎⁎
    • ,
  • Sunil Sabharwal, MD

      Affiliations

    • Spinal Cord Injury Service, VA Boston Health Care System, Boston, MA, and Harvard Medical School, Boston, MA††
    • ,
  • Eric Garshick, MD

      Affiliations

    • Research and Development Service, Department of Veterans’ Affairs, Boston Healthcare System, Boston, MA; Pulmonary and Critical Care Medicine Section, Medical Service, VA Boston, MA; Channing Laboratory Department of Medicine, Brigham and Women’s Hospital, Boston, MA; Harvard Medical School, Boston, MA‡‡

Received 25 September 2008; accepted 21 October 2008. published online 09 February 2009.

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.

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  • † Disclosure: nothing to disclose
  • ‡ Disclosure: 7A, co-investigation on Merck Frosst-funded study
  • § Disclosure: nothing to disclose
  •  Disclosure: nothing to disclose
  • ∥ Disclosure: nothing to disclose
  • # Disclosure: nothing to disclose
  • ⁎⁎ Disclosure: nothing to disclose
  • †† Disclosure: nothing to disclose
  • ‡‡ Disclosure: nothing to disclose

 Disclosure Key can be found on the Table of Contents and at www.pmrjournal.org

 The project reported/outlined here was supported by the Office of Research and Development, Health Services R&D Service, Quality Enhancement Research Initiative RRP-07-312, NIH/NICHD RO1 HD42141 (Dr. Garshick), R21HD057030 (Morse), and K12 HD001097-08 (Dr. Morse).

 The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs.

PII: S1934-1482(08)00019-1

doi:10.1016/j.pmrj.2008.10.008

PM&R
Volume 1, Issue 3 , Pages 240-244, March 2009

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