Pharmacological Prevention and Treatment of Bone Loss in Persons with Spinal Cord Injury: Implementation of the Paralyzed Veterans of America Clinical Practice Guidelines

Session approved for 1 ASRT Category A Credit
Session approved for up to 1 AMA PRA Category 1 Credits™

This session duration is 50 minutes.

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:

  • Define the PVA Bone Health and Osteoporosis management methods including ES diagrams, Risk of Bias tools, and grading process for recommendations.
  • Describe recommendations for the role of calcium and vitamin D intake for preventing bone loss and treating osteoporosis, including clinical considerations for the provision of dietary or supplementary forms of calcium and vitamin D.
  • Identify appropriate drug therapy for prevention and treatment of osteoporosis considering therapy efficacy, duration, and fracture history.

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 (, 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 ( and is Co-Primary Investigator for the Can-SCIP guidelines ( 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 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).; #@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.


Recorded Archive
Select the "View On-Demand Recording" button to begin.
Select the "View On-Demand Recording" button to begin.
03/31/2022 at 11:20 AM (EDT)   |  50 minutes
03/31/2022 at 11:20 AM (EDT)   |  50 minutes
10 Questions
Medical Certificate
Up to 1.00 medical credits available  |  No certificate available
Up to 1.00 medical credits available  |  No certificate available