Early treatment with zoledronic acid prevents bone loss at the hip following acute spinal cord injury

• Published in: Osteoporosis international 2011, Vol.22 (1), p.271-279
• Main Authors: Bubbear, J. S, Gall, A, Middleton, F. R. I, Ferguson-Pell, M, Swaminathan, R, Keen, R. W
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Biological and medical sciences; Biomarkers - metabolism; Bisphosphonate; Bone and Bones - metabolism; Bone density; Bone Density - drug effects; Bone Density Conservation Agents - administration & dosage; Bone Density Conservation Agents - therapeutic use; Bone Resorption - etiology; Bone Resorption - prevention & control; Bones, joints and connective tissue. Antiinflammatory agents; Cerebrospinal fluid. Meninges. Spinal cord; Diphosphonates - administration & dosage; Diphosphonates - therapeutic use; Diseases of the osteoarticular system; Drug Administration Schedule; Endocrinology; Female; Follow-Up Studies; Fractures; Hip Joint - physiopathology; Humans; Imidazoles - administration & dosage; Imidazoles - therapeutic use; Lumbar Vertebrae - physiopathology; Male; Medical sciences; Medicine; Medicine & Public Health; Nervous system (semeiology, syndromes); Neurology; Original Article; Orthopedics; Osteoporosis; Osteoporosis - etiology; Osteoporosis - physiopathology; Osteoporosis - prevention & control; Osteoporosis. Osteomalacia. Paget disease; Pharmacology. Drug treatments; Preventive medicine; Rheumatology; Spinal cord injuries; Spinal Cord Injuries - complications; Spinal Cord Injuries - physiopathology; Spinal cord injury; Young Adult; Zoledronic acid
• ISSN: 0937-941X; 1433-2965
• DOI: 10.1007/s00198-010-1221-6

Summary Osteoporosis after spinal cord injury is common. Reductions in bone density are rapid and fracture rates are higher after injury. Early treatment with 4 mg zoledronic acid significantly reduced bone loss at the hip compared to untreated individuals in the first year. Treatment appeared safe and well tolerated. Introduction Bone mineral density (BMD) is lost rapidly following spinal cord injury (SCI), predominantly in the lower limbs. Bone turnover markers suggest an early increase in resorption. Methods A randomised, open-label study of 14 patients with acute SCI randomised to receive 4 mg IV zoledronic acid or standard treatment. BMD was measured by dual-X-ray absorptiometry at the lumbar spine and hip (femoral neck, total and trochanter) at baseline, 3, 6 and 12 months. Bone turnover markers (serum C-terminal telopeptide and Procollagen I N-terminal peptide and urinary N-terminal telopeptide/Cr ratio) were also measured. Results After 12 months, there was a significant difference in BMD between the groups at the total hip (12.4%, p = 0.005), trochanter (13.4%, p = 0.028) and lumbar spine (2.7%, p = 0.033). However, the difference between groups at the femoral neck was not significant (4.8%, p = 0.741). In the treated group, bone resorption was reduced and remained reduced up to 12 months. Other than flu-like symptoms immediately after the infusion, no adverse events were observed. Conclusion IV zoledronic acid is an effective and well-tolerated treatment to prevent bone mineral density loss at the total hip and trochanter for up to 12 months following SCI.