The effect of zoledronic acid on attenuation of bone loss at the hip and knee following acute traumatic spinal cord injury: A randomized-controlled study

Model System:

SCI

Reference Type:

Journal article

Accession No.:

J89300

Journal:

Spinal Cord (formerly Paraplegia)

Year, Volume, Issue, Page(s):

2020 , 58, 8, 921-929

Publication Website:

Abstract:

Study examined the effect of early intravenous zoledronic acid (ZA) on bone markers and areal bone mineral density (aBMD) in people with acute traumatic spinal cord injury (SCI). ZA is the most potent of the bisphosphonates, a class of medication that affects the ability of the osteoclast to further resorb bone, resulting in relative bone preservation. Thirteen men and 2 women with traumatic SCI, aged 19 to 65 years, received 5 milligrams of intravenous ZA vs. placebo 12 to 21 days post injury. Markers of bone formation (procollagen N-1 terminal propeptide [P1NP]), bone resorption (serum C-telopeptide [CTX]), and aBMD by dual-energy X-ray absorptiometry for hip (femur—proximal, intertrochanteric, neck), and knee (distal femur, proximal tibia) were obtained at baseline, 2 weeks post infusion (P1NP, CTX only), and 4 and 12 months after injury. Analyses revealed that P1NP remained unchanged, while CTX decreased in ZA but increased in controls at 2 weeks (mean difference = −97 percent), 4 months (mean difference = −54 percent), but not 12 months (mean difference = 3 percent). Changes in aBMD at the hip favored ZA at 4 months and 12 months. At 4 months, changes in aBMD favored ZA at the distal femur but not proximal tibia. Both groups declined in aBMD at 12 months, with no between-group differences. This study demonstrates that ZA administered within 21 days of complete traumatic SCI maintains aBMD at the hip and distal femur at 4 months post injury. This effect is partially maintained at 12 months.

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