Can-SCIP Coach App
  1. Can-SCIP
  2. Recommendations
  3. Guidelines
  4. Section 2 - MANAGEMENT OF SCI COMPLICATIONS

L - BONE HEALTH




L.1.1
All adults with SCI resulting in permanent motor or sensory dysfunction should have a dual-energy X-ray absorptiometry (DXA) scan of the total hip, proximal tibia, and distal femur as soon as medically stable. (Adapted from BMD 2019, p.2; Level B)


L.2.1
In adults with SCI, total hip, distal femur, and proximal tibia bone density should be used to diagnose osteoporosis, predict lower extremity fracture risk, and monitor response to therapy where normative data are available. (Knee DXA Protocol: https://www.kite-uhn.com/clinical/tools/knee-dxa-protocol) (BMD 2019, p.4; Level B)
L.2.2
Serial DXA assessment of treatment effectiveness among individuals with SCI should include evaluation at the total hip, distal femur, and proximal tibia, following a minimum of 12 months of therapy at 1- to 2- year intervals. Segmental analysis of total hip, distal femur, and proximal tibia subregions from a whole-body scan should not be used for monitoring treatment. (BMD 2019 p.6; Level B)


L.3.1
There is no established threshold BMD value below which weight-bearing activities are absolutely contraindicated. BMD and clinical risk factors should be used to assess fracture risk prior to engaging in weight-bearing activities. (BMD 2019; p.7; Level C)


L.4.1
Individuals with incomplete SCI AIS D with lower extremity scores greater than or equal to 20 should be offered Etidronate to prevent sublesional osteoporosis, following a discussion of evidence-based benefits and risks. (CAN-SCIP 2020; Level A)
L.4.2
Individuals with motor complete SCI should be offered Alendronate (70 mg weekly), Zoledronate (5 mg IV) or Denosumab (60 mcg via subcutaneous injection) to maintain proximal and distal femur and proximal tibia BMD, following a discussion of evidence-based benefits and risks. (CAN-SCIP 2020; Level A)
L.4.3
Zoledronate should not be offered to individuals with renal impairment. (CAN-SCIP 2020; Level A)
L.4.4
Individuals with low bone mass should be offered vitamin D supplements to maintain lower extremity BMD. (CAN-SCIP 2020; Level A)
L.4.5
In individuals with SCI with low knee region BMD, FES cycling at least 3 times per week and 5 hours per week should be offered to maintain or improve knee region BMD in the areas stimulated, following a discussion of evidence-based benefits and risks. (CAN-SCIP 2020; Level C)