RESUMEN
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. CONCLUSION: 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.
Asunto(s)
Osteoporosis/etiología , Medicina Física y Rehabilitación/estadística & datos numéricos , Pautas de la Práctica en Medicina/estadística & datos numéricos , Traumatismos de la Médula Espinal/complicaciones , Absorciometría de Fotón , Enfermedad Aguda , Conservadores de la Densidad Ósea/uso terapéutico , Recolección de Datos , Difosfonatos/uso terapéutico , Manejo de la Enfermedad , Diagnóstico Precoz , Fracturas Espontáneas/diagnóstico , Fracturas Espontáneas/epidemiología , Fracturas Espontáneas/etiología , Francia/epidemiología , Humanos , Inmovilización/efectos adversos , Tamizaje Masivo , Osteoporosis/diagnóstico , Osteoporosis/tratamiento farmacológico , Osteoporosis/epidemiología , Osteoporosis/prevención & control , Medicina Física y Rehabilitación/métodos , Traumatismos de la Médula Espinal/epidemiología , Traumatismos de la Médula Espinal/rehabilitación , Encuestas y CuestionariosRESUMEN
OBJECTIVE: To present an up-to-date literature review of osteoporosis in spinal cord injury (SCI) patients, in view of the seriousness of this complication (with a high risk of fractures) and the complexity of its diagnosis, evaluation and treatment. METHODS: A Medline search with the following keywords: immobilization osteoporosis, spinal cord injury, bone loss, dual energy X-ray absorptiometry (DEXA), bisphosphonate. RESULTS: Our analysis of the literature noted a bone metabolism imbalance in SCI patients, with accelerated early bone resorption (particularly during the first 6 months post-injury). Although dual energy X-ray absorptiometry constitutes the "gold standard" diagnostic method, the decrease in bone mineral density only becomes significant 12 months after the injury. Bisphosphonate therapy has proven efficacy. Despite the frequent use of various physical therapies, these methods have not been found to be effective. CONCLUSION: Although our literature review did not identify any guidelines on the strategy for diagnosing and treating osteoporosis in SCI patients, several findings provide guidance on procedures for early diagnosis and preventive treatment.