Spinal cord injury providers' perspectives on managing sublesional osteoporosis.
Spinal cord injury providers' perspectives on managing sublesional osteoporosis.
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脊髓损伤提供者对治疗病变下骨质疏松症的看法。
DOI：
10.1080/10790268.2019.1704552
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发表时间：
2020
期刊：
影响因子：
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通讯作者：
Carbone,Laura
中科院分区：
文献类型：
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作者：
Weaver,FrancesM;Etingen,Bella;Guihan,Marylou;Ray,Cara;Priebe,Michael;Burns,Stephen;Carbone,Laura
目的：脊髓损伤（SCI）患者在损伤后会出现快速的病灶下骨丢失（1，3）。缺乏预防/管理SCI中骨质疏松症的证据。设计：电话采访SCI提供者。设置：VA SCI中心和诊所。参与者：退伍军人管理局SCI中心和诊所根据其双能X射线吸收测定（DXA）扫描的平均数量进行分类（FY 2014 -2016）。12 SCI供应商从高和低DXA订购网站进行了采访。问题包括骨质疏松症筛查/诊断、预防/治疗策略、骨质疏松症的继发原因和骨质疏松性骨折并发症。访谈录音，转录，和analyzed.Results：供应商描述了缺乏标准化的指导方针，在SCI管理骨质疏松症。他们最常在以下情况下使用DXA筛查骨质疏松症：（1）考虑使用新器械或活动，（2）有骨折史的患者。一些供应商认为，不能走动的SCI患者已经有骨质疏松症，所以很少订购DXA。评估骨质疏松症的次要原因是罕见的。确定的骨折预防策略包括负重和从事适应性运动等活动。维生素D和钙经常被规定为实验室测试中发现的缺陷的结果。供应商很少处方FDA批准的骨质疏松症药物。骨折后并发症包括骨不连/畸形愈合和骨筋膜室综合征。供应商表示，患者经常经历的心理压力，焦虑和抑郁fractional.Conclusion：供应商描述了缺乏证据的筛选和管理的SCI和骨质疏松症患者。未来的努力应包括制定循证指南，以帮助骨质疏松症管理的供应商。
Objective:Persons with spinal cord injuries (SCI) experience rapid sublesional bone loss following injury (1, 3). Evidence on preventing/managing osteoporosis in SCI is lacking. This project examined how providers manage bone loss in SCI.Design:Telephone interviews with SCI providers.Setting:VA SCI centers and clinics.Participants:Veterans Administration SCI centers and clinics were categorized on their average number of dual-energy X-ray absorptiometry (DXA) scans (FY2014-2016). Twelve SCI providers from high and low DXA-ordering sites were interviewed. Questions included osteoporosis screening/diagnosis, prevention/treatment strategies, secondary causes of osteoporosis, and osteoporotic fracture complications. Interviews were audio-recorded, transcribed, and analyzed.Results:Providers described a lack of standardized guidelines for managing osteoporosis in SCI. They most often screened for osteoporosis using DXA when: (1) considering use of a new device or activity, (2) for patients with a history of fracture. Some providers assumed that non-ambulatory SCI patients already have osteoporosis so infrequently ordered DXAs. Assessment of secondary causes of osteoporosis was uncommon. Fracture prevention strategies identified included weight-bearing and engaging in activities like adaptive sports. Vitamin D and calcium were frequently prescribed as a result of deficiencies identified during lab testing. Providers seldom prescribed FDA-approved medications for osteoporosis. Post-fracture complications encountered included nonunion/malunion and compartment syndrome. Providers indicated that patients often experienced psychological stress, anxiety and depression following fractures.Conclusion:Providers described a lack of evidence for screening and management of patients with SCI and osteoporosis. Future efforts should include developing evidence-informed guidelines to aid providers in osteoporosis management.