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Final Program


Final Program

1221 - Bone Health and Osteoporosis Management Clinical Practice Guidelines in Practice : our SCI Center's Quality Improvement Project

Thursday, February 27, 2025
5:00 PM - 6:30 PM MST
Objectives: For many decades it has been observed that people with spinal cord injuries have a higher incidence of osteoporosis and fractures.  Prior to 2022 there was no consensus about how to routinely evaluate bone health and screen for osteoporosis.  In 2022 the PVA (Paralyzed Veterans of America) published the bone health and osteoporosis management in individuals with spinal cord injury clinical practice guidelines.

Design: We are a VA spinal cord injury center.  We serve 1700 paralyzed veterans within our local and spoke sites and have a 100 bed inpatient SCI unit.  Before these guidelines came out we did not regularly screen our patients for osteoporosis.  Without a diagnosis of osteoporosis treatment options were not considered.
After evaluating our current practice, we found that we were not following the pathway outlined in the guidelines.  In order to address this we formed a bone health and fracture committee and developed a protocol based on the CPG pathway.  We updated our annual orders to include the recommended laboratory screening as well as DEXA including the distal femur and proximal tibia. 
This process change has had multiple system challenges, especially since multiple departments were required to participate.  We worked especially closely with our radiology department to coordinate the recommended DEXA including the knee.

Results:

We are able to monitor the effectiveness of our new process.  We have noted an increase in the number of patients diagnosed with osteoporosis and osteopenia, as well as an increase in the number of osteoporosis medications prescribed.  We have also had an increased number of therapy consults for fall prevention, standing and weight bearing activities.  

Conclusions: Despite multiple challenges, with the partnership of different departments (pharmacy, radiology, dental, rheumatology, endocrine) throughout our hospital we have been able to improve the monitoring of bone health in our paralyzed patients.