[Osteoporosis in spinal cord injury. Screening and treatment. Results of a survey of physical medicine and rehabilitation physician practices in France. Proposals for action to be taken towards the screening and the treatment].
OBJECTIVE
The management of osteoporosis in spinal cord injury that is a recurring issue in daily practice, but unfortunately, no standard protocol is provided by the literature review, either for screening or for a strategy of prevention and even for therapy. We assessed the practices of the physicians in physical medicine and rehabilitation from all over France, with the ultimate aim to propose a consensus for preventive and curative cares of that osteoporosis.


METHODS
A questionnaire was sent to practitioners engaged with spinal cord injury (SCI) patients residing in the center and patients in medical monitoring. The questionnaire consisted mainly of closed questions.


RESULTS
Twenty-six questionnaires are analyzed. The screening for osteoporosis is made routinely by only 19.2% of the practitioners and after a fracture in only 80.2% of the cases. The diagnosis of osteoporosis is based on bone densitometry (DEXA) (96%). Standing still remains a means of prevention for 88% of physicians in the acute phase and for 77% in the chronic phase. Ninety-two percent of practitioners treat at the stage of established osteoporosis.


CONCLUSIONS
There is generally no standardized management of osteoporosis in practice for SCI patients. The searching for osteoporosis is usually performed after a fracture. All the literature data and results of the questionnaire led us to propose a protocol consisting in a systematic monitoring of the bone mineral density for the screening of osteoporosis, but also a procedure for early diagnosis and for preventive treatment of osteoporosis in the acute phase.
Université de Saint-Etienne, hôpital Bellevue, CHU de Saint-Étienne, France. vegene@yahoo.fr
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V
Phaner
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Charmetant
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Condemine
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Fayolle-Minon
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MH
Lafage-Proust
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Calmels
D015502:Absorptiometry, Photon; D000208:Acute Disease; D050071:Bone Density Conservation Agents / Q000627:therapeutic use; D003625:Data Collection; D004164:Diphosphonates / Q000627:therapeutic use; D019468:Disease Management; D042241:Early Diagnosis; D005598:Fractures, Spontaneous / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D005602:France / Q000453:epidemiology; D006801:Humans; D007103:Immobilization / Q000009:adverse effects; D008403:Mass Screening; D010024:Osteoporosis / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D010810:Physical and Rehabilitation Medicine / Q000379:methods / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D013119:Spinal Cord Injuries / Q000150:complications* / Q000453:epidemiology / Q000534:rehabilitation; D011795:Surveys and Questionnaires
D050071:Bone Density Conservation Agents; D004164:Diphosphonates