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Critical Reviews™ in Physical and Rehabilitation Medicine
SJR: 0.121 SNIP: 0.228 CiteScore™: 0.17

ISSN Print: 0896-2960
ISSN Online: 2162-6553

Critical Reviews™ in Physical and Rehabilitation Medicine

DOI: 10.1615/CritRevPhysRehabilMed.v20.i4.10
pages 277-321

Sublesional Osteoporosis Prevention, Detection, and Treatment: A Decision Guide for Rehabilitation Clinicians Treating Patients with Spinal Cord Injury

Beverley Craven
Toronto Rehabilitation Institute, Spinal Cord Rehab Program, Toronto, ONTARIO; University of Toronto, Department of Medicine Toronto, Ontario
Lora Giangregorio
Toronto Rehabilitation Institute, Spinal Cord Rehab Program, Toronto, ONTARIO; University of Waterloo, Waterloo, Ontario
Lindsie Robertson
Toronto Rehabilitation Institute, Spinal Cord Rehab Program, Toronto, ONTARIO
Jude J. Delparte
Toronto Rehabilitation Institute, Spinal Cord Rehab Program, Toronto, ONTARIO
Maureen C. Ashe
University of British Columbia, Departments of Family Practice, Vancouver, British Columbia; Centre for Hip Health and Mobility, Vancouver, British Columbia
Janice J. Eng
University of British Columbia, Department Physical Therapy, Vancouver; GF Strong Rehab Centre Vancouver; ICORD Vancouver, British Columbia; Centre for Hip Health and Mobility, Vancouver, British Columbia

ABSTRACT

Background. Sublesional osteoporosis (SLOP) is characterized by excessive bone resorption at the hip and knee region after spinal cord injury (SCI), resulting in a lifetime increased risk of lower extremity fracture. There are no consensus guidelines to aid clinicians in the prevention or treatment of SLOP. Objectives. (1) To review risk factors, skeletal distribution, pathophysiology, and diagnosis of SLOP; (2) familiarize clinicians with the tools available to inform clinical decisions regarding the prevention and treatment of SLOP; and (3) synthesize results of relevant SLOP systematic reviews. Methods. We conducted a literature review by searching the MEDLINE/PubMed, CINAHL®, EMBASE, and PsycINFO databases for “SCI” and 14 other bone-related MeSH terms, including publications current to July 1, 2009. The incorporated articles were graded for rigor by using the 11-item Physiotherapy Evidence Database (PEDro) for randomized control trials and the 27-item Downs and Black tool for other intervention studies with scoring modifications. Implications. Rehabilitation clinicians can use tools to identify those acute and chronic SCI patients who will benefit from prevention or treatment of low bone mineral density in the hip or knee region, respectively. Therapy selection for SCI patients should stem from the best-available evidence, an understanding of literature limitations, and knowledge of the concurrent conditions that may influence the safety and efficacy of the intervention.


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