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L - Skeletal Integrity

Best Practice Indicators : The following best practice indicators are provided to assist program leaders in conducting self evaluation of their skeletal integrity services. Does your organization routinely: Incorporate bone health objectives into rehab goals? Include bone health in your patient education modules? Screen for secondary causes of osteoporosis, unrelated to SCI at rehab admission? Provide diet and lifestyle counselling? Ensure adequate, but not excessive dietary calcium intakes? Ensure adequate, but not excessive intakes of vitamin D? Measure BMD (including the knee region) at rehab admission one and two years, post injury, to assess the effectiveness of SLOP prevention strategies? Offer Bisphosphonate therapy, early post injury, to AIS A-B patients to prevent SLOP? Discuss the role of rehab interventions to attenuate the decline in bone mass, early after injury? Routinely measure BMD at > five years, post injury, to discern SLOP treatment effectiveness and fracture risk? Provide patients with SLOP and high fracture risk access to drug and rehab therapies, for treatment of SLOP? Assess fall risk and/or need for functional upgrading to prevent falls? Ameliorate fracture risk through multidisciplinary team intervention? Provide post fracture care for patients, lower extremity fragility fracture? Provide rehab services for patient with SLOP-related complications: lumbar compression fracture, scoliosis, etc? Provide access to novel therapy, or evolving technology to augment bone mass? Evaluate effectiveness of SLOP interventions? Abandon ineffective therapy? Advocate for appropriate policy changes to support bone health service implementation? Roadmap - Where Should We Go? Clinical Goals • Universal access to DXA testing for individuals with subacute SCI followed by routine, annual knee region BMD measurement and fracture risk assessment, for individuals with chronic SCI • Support development and implementation of bone health clinics, whose mandate includes the diagnosis and management of SLOP, fracture prevention and post-fracture treatment protocols, for individuals with SCI. • Inclusion of Bone Health Assessment, including BMD interpretation and fracture risk appraisal, as SCI objectives in the core PMR residency training programs. Research Goals • Identify a valid, cost-effective means of identifying individuals with high fracture risk. • Priority funding of research projects which explore the pathophysiology of the muscle-bone unit, and its role in sustaining bone mass and maintaining skeletal integrity, is recommended • Current osteoporosis intervention trials have identified increases in lower extremity BMD, as a proxy outcome for fracture reduction. Development and funding of multicentre clinical studies, with an adequate sample size, to evaluate treatment efficacy and fracture risk reduction as a primary goal, should be a community priority. • Develop an authoritative understanding of the epidemiology and economic impact of SLOP, and fracture risk, after SCI Key Policy Goals • Lobby for national diagnostic imaging accessibility standards to enable routine assessment of skeletal integrity. • Create DXA billing codes that reflect the time requirements and complexity of SCI patient assessment and management, to engage current, national osteoporosis experts in the assessment and management of individuals with SCI, SLOP and high fracture risk. SKELETAL INTEGRITY | BODY STRUCTURE AND FNUCTION 125


L - Skeletal Integrity
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