In the following sections, prevention and treatment interventions for maintaining bone health after SCI are discussed. As bone loss is greatest immediately following SCI, in this review pharmacological and non-pharmacological interventions are classified as either prevention (the participants are less than 1 year post SCI) or treatment (study involved participants who are > 1 year after the injury). The intent is to address two distinct clinical questions: 1.What is the best way to prevent acute regional declines in bone mineral density?; and 2. What are the best treatments for low bone mass of the hip and knee region for people with longstanding SCI?

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.