title: VA-based survey of osteoporosis management in spinal cord injury.
abstract: 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.
  
  
  METHODS
  Online survey regarding osteoporosis management in SCI composed of 27 questions designed to gather information on responder demographics, osteoporosis diagnostics, and treatment options.
  
  
  METHODS
  VA health care system.
  
  
  METHODS
  VHA National SCI Staff Physicians and VHA National SCI Nurses (total n = 450) were sent an email with an invitation to participate.
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  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.affiliation: Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Boston, MA, USA. lmorse4@partners.org
authors.forename: Leslie R
authors.initials: LR
authors.lastname: Morse
authors.forename: Lora
authors.initials: L
authors.lastname: Giangregorio
authors.forename: Ricardo A
authors.initials: RA
authors.lastname: Battaglino
authors.forename: Robert
authors.initials: R
authors.lastname: Holland
authors.forename: B Catharine
authors.initials: BC
authors.lastname: Craven
authors.forename: Kelly L
authors.initials: KL
authors.lastname: Stolzmann
authors.forename: Antonio A
authors.initials: AA
authors.lastname: Lazzari
authors.forename: Sunil
authors.initials: S
authors.lastname: Sabharwal
authors.forename: Eric
authors.initials: E
authors.lastname: Garshick
mesh_terms: D015502:Absorptiometry, Photon / Q000706:statistics & numerical data*; D000328:Adult; D050071:Bone Density Conservation Agents / Q000627:therapeutic use*; D003625:Data Collection; D005260:Female; D006787:Hospitals, Veterans; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D009722:Nurse Practitioners; D010024:Osteoporosis / Q000175:diagnosis* / Q000209:etiology / Q000517:prevention & control*; D010823:Physician Assistants; D010820:Physicians; D010818:Practice Patterns, Physicians'; D013119:Spinal Cord Injuries / Q000150:complications* / Q000534:rehabilitation
chemical_list: D050071:Bone Density Conservation Agents