SCI and Osteoporosis

Bone loss below the level of injury is quite common during the first 6-18 months post spinal cord injury. Prevention of bone loss and treatment of osteoporosis below the level of injury lack internationally accepted guidelines. Your experience and everyday clinical practice will add important information to this unclear treatment approach in a serious secondary condition, that causes complications as low force fractures.

To avoid misinterpretations, we suggest a joint agreement on: acute phase: up to 3 months post-SCI, post-acute phase: 4-18 months post-SCI, chronic phase: more than 18 months post-SCI.

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* 1. What is your specialty?

Spinal cord specialist

Physical & Rehabilitation Medicine physician / Physiatrist

Neurologist

Neurosurgeon

Orthopedic surgeon

Other (please specify)

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* 2. For how many years have you practiced your specialty?

< 5 Years

5 – 10 Years

10 - 20 Years

> 20 years

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* 3. Do you measure bone loss in persons with SCI? (more than one answer can be chosen)

YES, in acute phase (up to 3 months post injury)

YES, in post-acute phase (4-18 months post-SCI)

YES, in chronic phase (more than 18 months)

After a low impact fracture

When the patient requests it

Never. (please go to question 6)

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* 4. How frequently do you screen persons with SCI for bone loss?

Every 6 months for the first 2 years

Every year

Every 2 years

Other (please specify)

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* 5. If you measure bone loss in persons with SCI, which tests do you use? (more than one answer can be chosen)

Calcium levels in serum and urine

PTH

25 (OH) VitD3

Crosslaps

DXA of spine

DXA of hip

DXA of hand

Whole body DXA (muscle and fat assessment too)

Peripheral quantitative computed tomography - pQCT (If YES, please specify where in the "other" box below - tibia, femur, radius, etc.)

Other (please specify)

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* 6. How do you prevent bone loss in the acute & post-acute phase of SCI?

No therapeutic approach

Mobilization only, no drugs

Mobilization, Vit D3 +/- calcium

Mobilization and antiosteoporotic drugs

Other (please specify) (for example FES, vibration therapy or other drugs)

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* 7. Which therapeutic approach do you prefer for continued bone loss (abnormal blood and urine tests) during the acute & subacute phase in order to stop bone loss (more than one answer can be chosen)

No therapeutic approach

Bisphosphonates i.v. in acute phase post injury (up to 3 months post injury)

Bisphosphonates oral after patients have succeed erect position (on tilt –table, etc.)

Denosumab subcutaneously in post-acute phase (4-18months post-SCI)

Calcium

Vit D

Mobilization

Other (please specify)

Question Title

* 8. Which therapeutic approach do you prefer in the chronic phase of SCI in order to manage osteoporosis below the level of injury? (more than one answer can be chosen)

None

Consultation of lifestyle changes in order to prevent fragility fractures

Medications only after low force fractures have occurred

Calcium

Vit D

Oral bisphosphonates

i.v. bisphosphonates

subc. Denosumab

PTH analogue

Mobilization

Other (please specify)

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* 9. When do you prescribe calcium?

Never, due to complications of kidney or/and cardiovascular system

In acute phase (up to 3 months post injury)

In post-acute phase (4-18months post-SCI)

Only in chronic phase (>18months post SCI)

Other (please specify)

Question Title

* 10. Do you prescribe vitamin D, if levels of 25(OH) Vit D are low?

Never

Yes, always after acute phase

Yes, always even in acute phase

Yes, only in chronic phase (>18months post SCI)

I don’t routinely check 25-OH Vit D levels

Question Title

* 11. Which therapeutic approach do you prefer when a patient has had a low trauma fracture? (more than one answer can be chosen)

None

Consultation of lifestyle changes in order to prevent fragility fractures

Calcium

Vit D

Oral bisphosphonates

I.V. bisphosphonates

subc. Denosumab

PTH analogue

Mobilization

Other (please specify)

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* 12. In your opinion, what scores in DXA reflect osteoporosis in persons with SCI? (more than one answer can be chosen)

Those according to the World Health Organization (WHO) definitions of osteoporosis for post-menopausal women and men age 50 or older: T-score is used to classify hip (total hip/femoral neck) bone density as normal (T-score >-1), osteopenia (T-score -2.5) and osteoporosis (T-score <-2.5).

Those according to the World Health Organization (WHO) definitions of osteoporosis for premenopausal women and men under the age of 50: Z-score is used to classify bone density at the hip as follows: normal (Z-score >-2) or as lower than expected for age and sex (Z-score < -2).

Other (please specify)

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* 13. Do you use other methods to promote bone mineral density (BMD) (i.e. FES, vibration)?

Yes

Other (please specify)