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Clinical Guide

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In the following sections, prevention and treatment interventions for maintaining bone health after SCI are discussed. Two distinct clinical questions can be posed regarding bone loss after SCI: (1) What is the best way to prevent acute regional declines in bone mineral density in the early post-injury period (10-90 days post injury)? and (2) What are the best treatments for established low bone mass and increased fracture risk of the hip and knee region for individuals  with chronic (>2 years) SCI?

Bone loss is greatest in the first year post-SCI. Therefore, this review classifies intervention studies as either prevention studies (i.e. the participants are less than 6 months post-SCI) or treatment studies (i.e. study participants are ≥1 year post-SCI). Within the prevention and treatment categories, this review discusses (a) pharmacological intervention studies, (b) non-pharmacological intervention studies, and (c) studies of combination interventions (e.g. drug therapy concurrent with a rehabilitation intervention).

When selecting a treatment to offer patients, clinicians seek the best available evidence to support their practice.  Ideally, one would like to see three randomized control trials (Level 1 evidence) from separate centres demonstrating the efficacy of a therapy prior to routine implementation.  Having highlighted this issue, the diversity of interventions, study design and outcome measures make interpretation of the SCI bone health literature challenging and subject to controversy. The following sections attempt to identify the best available literature to address specific clinical questions.