Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2009;32(3):215-25.
doi: 10.1080/10790268.2009.11760776.

Bisphosphonate use in acute and chronic spinal cord injury: a systematic review

Julia E Bryson  1 , Margaret L Gourlay
Affiliations

Bisphosphonate use in acute and chronic spinal cord injury: a systematic review

Julia E Bryson et al. J Spinal Cord Med. 2009.

Abstract

Background/objective: Bone density loss occurs rapidly after traumatic spinal cord injury (SCI) and is associated with low-energy fractures below the level of injury, commonly occurring around the knee. Bisphosphonates have been tested as potential agents to prevent bone loss after SCI, but no guidelines exist for clinical use of bisphosphonates in these patients. The objective of this study was to systematically review and evaluate evidence quality in studies of bisphosphonate use in patients with post-treatment follow-up of sublesional bone mineral density.

Methods: Literature search in MEDLINE/PubMed and ISI database using key words bisphosphonates, spinal cord injury, quadriplegia, paraplegia, and tetraplegia.

Results: The search identified 6 experimental studies and 1 quasi-experimental study of bisphosphonate therapy in patients with acute and chronic SCI. The studies were small and of fair or poor quality, and none included fracture outcomes. Mild attenuation of bone density loss with acute administration of bisphosphonates after SCI was found at some measurement sites but was not always maintained during follow-up.

Conclusions: Data were insufficient to recommend routine use of bisphosphonates for fracture prevention in these patients. Current studies are limited by heterogeneity of patient populations and outcome measures. Uniform bone density measurement sites with rigorous quality control and compliance monitoring are needed to improve reliability of outcomes. Future studies should address specific populations (acute or chronic SCI) and should assess fracture outcomes.

PubMed Disclaimer

References

    1. Eser P, Frotzler A, Zehnder Y, et al. Relationship between the duration of paralysis and bone structure: A pQCT study of spinal cord injured individuals. Bone. 2004;34(5):869–880. - PubMed
    1. Lazo MG, Shirazi P, Sam M, Giobbie-Hurder A, Blacconiere MJ, Muppidi M. Osteoporosis and risk of fracture in men with spinal cord injury. Spinal Cord. 2001;39(4):208–214. - PubMed
    1. Zehnder Y, Luthi M, Michel D, et al. Long-term changes in bone metabolism, bone mineral density, quantitative ultrasound parameters, and fracture incidence after spinal cord injury: a cross-sectional observational study in 100 paraplegic men. Osteoporos Int. 2004;15(3):180–189. - PubMed
    1. Hitzig SL, Tonack M, Campbell KA, et al. Secondary health complications in an aging Canadian spinal cord injury sample. Am J Phys Med Rehabil. 2008;87(7):545–555. - PubMed
    1. CDC, National Center for Injury Prevention and Control. Spinal cord injury (SCI): fact sheet. http://www.cdc.gov/ncipc/factsheets/scifacts.htm. Accessed March 15, 2009.

Publication types

MeSH terms

Substances