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Figure 8.0 Protocol for the diagnosis, initiation and evaluation of treatment effectivenes for SLOP. CHECK TREAT FOLLOW UP Health • Medical history • Concomitant medication • Serum and urine screen NO Lifestyle • Caffeine > 3/day • Smoking history When completed, proceed • Alcohol > 2/day or binge drinking NO Nutrition YES When completed, proceed • Calcium > 3 servings/day • Vitamin D, 25-OH < 25nmol/L NO Bone Factors YES When completed, proceed • Knee region BMD < 0.49g/cm2 • > 2 risk factors for fracture • Prior fragility fracture Health • Treat conditions identified • Decrease or change medication • Correct/monitor serum/urine markers Lifestyle • Limit caffeine ≤ 3/day • Smoking cessation • Alcohol cessation or ≤ 2/day Health • Evaluate treatment effectiveness • Monitor serum/urine markers • Monitor changes in knee BMD Non-Responsive Patients • Assess adherence • Stop therapy or implement Alternate therapy Reprinted from Crit Rev Phys Rehabil Med, 20(4), Craven BC, Giangregorio LM, Robertson LA, Delparte JJ, Ashe MC, Eng JJ, Sublesional Osteoporosis Prevention, Detection and Treatment: A Decision Guide for Rehabilitation Clinicians Treating Patients with Spinal Cord Injury, p.290, Copyright (2008), with permission from Begell House, Inc. Nutrition • Calcium 1000 mg/day • Vitamin D, 25-OH > 100nmol/L Bone Factors • Alendronate/rehab therapy • Address modifiable risk factors • Counsel re: fracture prevention YES YES Evolving Evidence Likely to Influence SLOP Treatment Battaglino RA, Lazzari AA, Garshick E, Morse LR. Spinal cord injury-induced osteoporosis: pathogenesis and emerging therapies published online ahead of print September 16 2012. Curr Osteoporos Rep. 2012. • Evaluation of the efficacy of whole body vibration for treatment of SLOP (NCT00624988) • Comparison of the efficacy of zoledronic acid and FES rowing to treat SLOP (NCT01426555) • Pilot RCT confirming the efficacy of alendronate for treatment of SLOP (NCT01131884) • Studies evaluating the efficacy of concurrent administration of drug and rehab interventions, on bone mass and bone architecture (e.g., rPTH and weight bearing (NCT00826228) • Study evaluating the efficacy of two forms of LE ergometry for augmenting bone and muscle mass (NCT01244594). 122 CAPTURING CAPACITY IN CANADIAN SCI REHABILITATION


L - Skeletal Integrity
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