Learning Center

Learning Center

Pharmacological Prevention and Treatment of Bone Loss in Persons with Spinal Cord Injury

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Activity approved for 1.5 ASRT Category A Credits
Activity approved for up to 1.5 AMA PRA Category 1 Credits™
Activity Expires February 1, 2024

Activity Description

The purpose of this session will be to provide an overview of the methods used to develop the PVA Bone Health CPG and the appropriate drug therapy for the prevention and treatment of osteoporosis in persons with SCI.

Learning Objectives

  1. The attendee should understand the amount of vitamin D recommended after spinal cord injury.
  2. The attendee should understand the amount and route of administration recommended for calcium after spinal cord injury, and how it is modified in patients with kidney stones.
  3. The attendee should understand the agents available for the prevention of bone loss after spinal cord injury and should prioritize administration of those with a proven track record both for efficacy and safety in patients with spinal cord injury.


Clinicians and Technologists are required to answer a set of online test questions following the review of the video and will have up to three attempts to answer questions correctly before losing credit for the activity. Once the activity test has been passed (75% or higher), you will be asked to evaluate the activity online and then be allowed to claim credit and print certificates.

Registration Fees


Cancellation Policy

On-Demand/ Enduring Material Cancellation
Purchases of on-demand or enduring educational materials are non-refundable.

On-Demand/Enduring Material Program Changes or Cancellations 
ISCD reserves the right to cancel the program, change dates, and/or the location/method of offering. All program fees will be refunded if a program is canceled unless the registered participant elects to transfer to another program.

ACCME Accreditation Statement

The International Society for Clinical Densitometry is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to offer continuing medical education for physicians. This activity is provided by the International Society for Clinical Densitometry. For information about the accreditation of this program, please contact ISCD at +1.860.259.1000 or inquire at education@iscd.org.

AMA PRA Category 1 Credit(s)™

The International Society for Clinical Densitometry designates this enduring educational activity for a maximum of 1.50 AMA PRA Category 1 Credits™. Physicians should only claim credits commensurate with the extent of their participation in the activity.

ASRT Credit Designation 

This activity has been approved by ASRT for 1.50 Category A continuing education credits.

Date of Original Release and most recent Review or Update 

This activity was most recently reviewed and released on January 13, 2023, and will expire on February 1, 2024

Dr. Christopher Cirnigliaro, PhD


James J. Peters VA Medical Center

Dr. Christopher M. Cirnigliaro, is the research laboratory manager and Investigator for the Veterans Affairs Rehabilitation, Research, and Development National Center for the Medical Consequences of Spinal Cord Injury located at the James J. Peters VA Medical Center. He is a clinical exercise physiologist and certified bone densitometry technician, with expertise in DXA analysis. His research investigates the prevention and reversal of bone and muscle loss after SCI, including clinical trials of bisphosphonates and denosumab, and extensive cross-sectional documentation of body composition changes following SCI. Dr. Cirnigliaro was also a member of the ISCD task force to develop the bone density testing guidelines in persons with SCI and is currently a member of the committee assigned to write the Clinical Practice Guideline entitled “Bone Health and Osteoporosis Management in Individuals with Spinal Cord Injury” that is sponsored by the Paralyzed Veterans of America.

Disclosures: No relationships to disclose.

Anthony Scott. Burns, MD MSc

Professor of Medicine, University of Toronto

UHN - Toronto Rehabilitation Institute, Lyndhurst Centre

Anthony S. Burns graduated from the Yale University School of Medicine in 1994, and afterwards completed combined residency training in Internal Medicine and Physical Medicine & Rehabilitation at the Sinai Hospital of Baltimore - Johns Hopkins University program, followed by a SCI fellowship at the University of Alabama at Birmingham. He is a past participant in the Rehabilitation Medicine Scientist Training Program, sponsored by the Association of Academic Physiatrists (AAP) and funded by the U.S. National Institutes of Health. From 2000 through 2007, he was Assistant Professor, Department of Rehabilitation Medicine, Thomas Jefferson University, Philadelphia PA; Assistant Director of the Regional SCI Center of the Delaware Valley; and adjunct Assistant Professor, Department of Neurobiology and Anatomy, Drexel University College of Medicine, Philadelphia PA. In 2007, Dr. Burns joined the University Health Network - Toronto Rehabilitation Institute Spinal Cord Rehabilitation Program, the largest program of its kind in Canada, and was the Medical Director from 2007 – 2012. Currently he is a Professor in the Division of Physiatry, Department of Medicine, University of Toronto, and Affiliate Scientist, Neural Engineering and Therapeutics (NET) Team of the KITE (Knowledge Innovation Talent Everywhere) Research Institute. His clinical and research interests focus on the determination and measurement of outcomes following SCI, as well as the clinical management of spinal cord injuries and related secondary complications.

Disclosures: No relationships to disclose.

Beverley Catharine Craven, MD, MSc, FRCPC, FASIA, FCAHS

Senior Scientist, Professor

UHN - Toronto Rehabilitation Institute, Lyndhurst Centre

Beverley. Catharine ( Cathy) Craven, BA, MD, FRCPC. MSc, FASIA, FCAHS Cathy Craven is the Toronto Rehabilitation Institute/ University of Toronto Chair in Spinal Cord Injury (SCI) Rehabilitation, Professor in the Department of Medicine at the University of Toronto, Medical Director of the Spinal Cord Rehabilitation Program and a Senior Scientist at KITE Research Institute within University Health Network. Dr Craven is a Fellow of the Canadian Academy of Health Sciences and a Fellow of the American Spinal Injury Association She has clinical and research expertise in health services and medical rehabilitation after Spinal Cord Injury. Dr. Craven is Chair of the Canadian SCI - Rehabilitation Association (www.cscira.org), Panel Chair for the 2021 PVA Consortium’s Bone Health and Osteoporosis Management Clinical Practice Guideline and participated in develpment of the ISCD 2019 Position Statement Regarding Bone Density Testing After Spinal Cord Injury. She leads the Canadain National SCI Implementation and Evaluation Quality Care Consortium (www.sciconsortium.ca) and is Co-Primary Investigator for the Can-SCIP guidelines (https://kite-uhn.com/can-scip)... Craven has deveoped and implemented a tool for measruing distal fmeur and proximal tibia BMD for individuals with SCI using a poly carbonate positioning device and the Hologic lumbar spine software https://www.kite-uhn.com/clinical/tools/knee-dxa-protocol. She has published over 200 articles on related topics and obtained 21.M dollars in research funding as a primary investigator (ORCID 0000-0001-8234-6803). www.cravenlab.ca; #@drcathycraven


Canadian Spinal Cord Injury Rehabilitation Association (Self) : Board Member/Advisory Panel (Status: Ongoing); CIHR (Self) : Operating Grant (Status: Ongoing), Other Financial or Material Support (Status: Ongoing), Research Support (Status: Ongoing); Coloplast (Self) : Other Financial or Material Support (Status: Ongoing), Unrestricted education funds (Status: Ongoing); Craig H Nielsen Foundation (Self) : Other Financial or Material Support (Status: Ongoing), Research Support (Status: Ongoing), Reviewer Stipend (Status: Ongoing); KITE Research Institute/University of Toronto (Self) : Other Financial or Material Support (Status: Ongoing), Research Support (Status: Ongoing), Sale and Distrbution of Knee positioners (Status: Ongoing); Ministry of Health Ontario (Self) : Research Support (Status: Ongoing); Praxis Spinal Research Institute (Self) : Board Member/Advisory Panel (Status: Ongoing), Consultant (Status: Ongoing), Research Support (Status: Ongoing); PVA (Self) : Other Financial or Material Support (Status: Terminated --- ), Travel Expenses (Status: Terminated --- )

Jenny Kiratli, PhD (Moderator)

Director of SCI Clinical Research

Spinal Cord Injury & Disorders Center, VA Palo Alto Health Care System

B. Jenny Kiratli, PhD, Director of Spinal Cord Injury Clinical Research, SCI/D Center, VA Palo ALto Health Care System. Dr Kiratli has over 35 years' experience conducting research on skeletal response to paralysis due to spinal cord injury. She received her PhD in 1989 from the University of Wisconsin-Madison; her dissertation was entitled "Skeletal adaptation to disuse: Longitudinal and cross-sectional study of the response of the femur and spine to immobilization (paralysis)." She had the opportunity to work with Dr Richard Mazess at Lunar Corp while conductng her PhD work and became an expert in DXA assessment in this unique population. In 1991, she was recruited to the VA Palo Alto Health Care System SCI Center where she developed a comprehensive research program encompassing musculoskeletal and cardiometabolic concerns for individuals living with SCI with an additional focus on activity and community recreation. Her current funding from VA Rehabilitation R&D supports a study entitled, "Assessing Bone Health after SCI: Establishing Evidence for a Clinical Protocol," that entails comparison of various DXA protocols for BMD of the proximal tiba and distal femur to establish precision in a non-injured reference cohort as well as those with SCI. Recently, she served on both groups working on clinical recommendations relevant to patients with SCI, the SCI Consortium Clinical Practice Guidelines for Bone Health after Spinal Cord Injury and the Orthopaedic Trauma Association Task Force on Fracture Management for SCI, both expected to be released in the Spring of 2022..

Disclosures: No relationships to disclose.

Course Planners and Managers

Harold Rosen, MD, CCD No Financial Relationships to Disclose
Wendy Tolman-Andrews, CBDT No Financial Relationships to Disclose
Peter Brown, MS No Financial Relationships to Disclose
Jesse Palmer No Financial Relationships to Disclose

Course Content Reviewers

William Leslie MD, FRCPC, MSc, CCD,  No Financial Relationships to Disclose

Course Faculty, Moderators, and Content Authors

Jenny Kiratli, Ph.D. No Financial Relationships to Disclose
Anthony Scott Burns, MD, MSc, No Financial Relationships to Disclose
Beverly Catherine Craven, Board Member/Advisory - Canadian Spinal Cord Injury Rehab Assoc; Praxis Spinal Research Institute Research Support - CIHR; Craigh H Nielsen Foundation; KITE Research Institute; Ministry of Health Ontario; Praxis Spinal Research Other - Coloplast; Craig H Nielsen Foundation; KITE Research Institute; PVA
Christopher M Cirnigliaro, PhD., CBDT, No Financial Relationships to Disclose


Statement of Independence

The ISCD maintains a policy on the use of commercial support, which ensures that all educational activities sponsored by the ISCD provide in-depth presentations that are fair, balanced, independent, and scientifically rigorous. ISCD requires faculty, planners, managers and other individuals and their spouse/life partner who are in a position to control the content of this activity to disclose any real or apparent conflict of interest they may have as related to the content of this activity. All identified conflicts of interest are thoroughly vetted by ISCD for fair balance, scientific objectivity of studies mentioned in the materials or used as the basis for content, and appropriateness of patient care recommendations. Individual disclosures are included in course material. No Commercial Support has been provided for this activity


The information and suggestions presented at the courses, seminars and other programs sponsored by ISCD and other collaborating societies are subject to change and therefore should serve only as a foundation for further investigation and study. Any forms presented at our seminars or programs are samples only and are not necessarily authoritative. All information, procedures, and forms contained or used in such seminars or programs should serve only as a guide for use in specific situations.

Disclosure of Unlabeled Use 

This educational activity may contain a discussion of published and/or investigational uses of agents that are not indicated by the FDA. ISCD does not recommend the use of any agent outside of the labeled indications. The opinions expressed in this educational activity are those of the faculty and do not necessarily represent the views of any organization associated with this activity. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Privacy & Confidentiality Statement

The ISCD will record learner’s personal information as provided on evaluations to allow for issuance and tracking of CME/CE certificates. The ISCD may also track aggregate responses to questions in activities and evaluations and use these data to inform the ongoing evaluation and improvement of its educational program. No individual performance data or any other personal information collected for evaluations will be shared with third parties

Attendee Cancellation Policy

All changes in registration must be made in writing to education@iscd.org. Purchase of on-demand or enduring educational materials are non-refundable.

Course Changes or Cancellations

ISCD reserves the right to cancel the program, change dates, and/or the location/method of offering. All program fees will be refunded if a program is canceled unless the registered participant elects to transfer to another program. 


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Pharmacological Prevention and Treatment of Bone Loss in Persons with Spinal Cord Injury
Open to view video.  |  60 minutes
Open to view video.  |  60 minutes Pharmacological Prevention and Treatment of Bone Loss in Persons with Spinal Cord Injury recording from the 2022 Annual Meeting
Learning Assessment
12 Questions  |  3 attempts  |  9/12 points to pass
12 Questions  |  3 attempts  |  9/12 points to pass Please complete this learning assessment with at least 9 correct answers to gain your credits
Activity Survey
10 Questions
10 Questions Please complete this brief survey to provide ISCD with feedback on this activity and improve future offerings.
Continuing Education Certificate
Up to 1.50 medical credits available  |  Certificate available
Up to 1.50 medical credits available  |  Certificate available This component will allow the participant to claim the appropriate credit for the activity. You must complete the acknowledgment, video, and activity survey to be able to claim credits. Please note - certificates will be available via the ISCD website at myProfile -> myLearning -> ISCD education page - https://my.iscd.org/My-ISCD/My-Learning/ISCD-Education-Credits. You can also reprint the certificate from this tab until the activity end date, at which time you will need to access via your myProfile page.
How To Access Your Certificate
Open to view video.
Open to view video. You can access your certificate by clicking on Continuing Education Certificate task under the Course Access tab at https://learn.iscd.org. After the course ends, you can access at https://my.iscd.org/My-ISCD/My-Learning/ISCD-Education-Credits or by following the instructions in the video.