Zoledronic Acid Attenuates Early Bone Loss at Forearm in Patients with Acute Spinal Cord Injury

Abstract

Study design

Randomized controlled trial.

Objectives

To study the magnitude of bone loss at forearm in persons with acute spinal cord injury (SCI) & the effect of early administration of Zoledronic acid on its’ prevention.

Settings

Sawai Man Singh Medical College, Jaipur, India.

Methods

Sixty patients with acute SCI were randomized either to receive standard medical and nursing care or Zoledronic acid infusion in combination with standard medical and nursing care. Areal bone mineral density (aBMD) was measured at the forearm (radius + ulna) once patients were medically stable using Dual Energy X-Ray Absorptiometry (DXA) at baseline and at 3, 6 and 12 months.

Results

Significant differences in aBMD was found between the control & Zoledronic acid group at 1/3 forearm (− 0.064; 95% CI − 0.092 to − 0.036, p = 0.001), mid forearm (− 0.059; 95% CI − 0.084 to − 0.034, p = 0.001), UD forearm (− 0.048; 95% CI − 0.097 to 0.001, p = 0.016) and total forearm (− 0.048; 95% CI − 0.088 to − 0.008, p = 0.021) at 1 year in the paraplegic patients with SCI. Similar significant difference was also observed at 1/3 forearm (− 0.046; 95% CI − 0.073 to − 0.019, p = 0.002), mid forearm (− 0.063; 95% CI − 0.088 to − 0.037, p < 0.0001), UD forearm (− 0.084; 95% CI − 0.101 to − 0.067, p < 0.0001) and total forearm (− 0.115; 95% CI − 0.132 to − 0.097, p < 0.0001) respectively at 1 year in the quadriplegic patients with SCI. Significant differences in aBMD between the groups at 6 months post infusion was also observed at these sites in quadriplegic patients. [1/3 forearm − 0.022; 95% CI − 0.039 to − 0.005; p = 0.015, Mid forearm − 0.023; 95% CI − 0.042 to − 0.004; p = 0.019, UD forearm − 0.041; 95% CI − 0.055 to − 0.027; p < 0.0001 and Total forearm − 0.049; 95%CI − 0.062 to − 0.036; p < 0.0001]. Bone loss was reduced in the Zoledronic acid treated group compared to the standard treatment group in both paraplegic and quadriplegic patients.

Conclusion

Single dose of 5mg intravenous Zoledronic acid is an effective treatment in preventing bone loss at the forearm for 12 months following acute spinal cord injury.

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Correspondence to Satyaranjan Sethi.

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The authors do not declare any conflicts of interests.

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Institute ethical committee clearnce was taken for the study. Also the study was registered in Clinical Trials Registry-India (CTRI/2018/03/012408).

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Written informed consent was taken from all the study participants.

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Goenka, S., Sethi, S. Zoledronic Acid Attenuates Early Bone Loss at Forearm in Patients with Acute Spinal Cord Injury. JOIO (2020). https://doi.org/10.1007/s43465-020-00158-8

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Keywords

  • Bone loss
  • Osteoporosis
  • Spinal cord injury (SCI)
  • Zoledronic acid
  • Bisphosphonate
  • Dual energy x-ray absorptiometry (DXA)