AI Article Synopsis

  • Accelerated bone loss is common in the first 2-3 years after traumatic spinal cord injury (TSCI), especially in the distal femur and proximal tibia, with limited studies focused on treating this condition.
  • A study conducted from 2018 to 2023 involved two groups: an 'acute interventional cohort' receiving zoledronic acid (ZOL) and a 'chronic non-interventional cohort' not receiving treatment, both monitored for bone mineral density (BMD) over time.
  • Results showed that the acute group, despite receiving ZOL, experienced significant BMD decline at 12 and 48 months, indicating that this treatment did not effectively prevent bone loss, highlighting the need for further research on

Article Abstract

Accelerated sub-lesional bone loss is common in the first 2-3 years after traumatic spinal cord injury (TSCI), particularly in the distal femur and proximal tibia. Few studies have explored efficacy of antiresorptives for acute bone loss prevention post-TSCI, with limited data for knee bone mineral density (BMD) or beyond two years follow-up. An open-label non-randomized study was performed at Royal North Shore Hospital and Royal Rehab Centre, Sydney between 2018 and 2023. An 'acute interventional cohort' (n = 11) with TSCI (duration ≤ 12-weeks) received a single infusion of 4 mg zoledronic acid (ZOL) at baseline. A 'chronic non-interventional cohort' (n = 9) with TSCI (duration 1-5-years) did not receive ZOL. All participants underwent baseline and 6-monthly blood tests (including CTx and P1NP) and 12-monthly DXA BMD scans (including distal femur and proximal tibia). Participants were predominantly Caucasian and male (mean age 38.4 years). At baseline, the 'acute' cohort had higher serum CTx, P1NP and sclerostin concentrations, while the 'chronic' cohort had lower left hip and knee BMD. Majority with acute TSCI experienced an acute phase reaction after ZOL (9/11; 82%). In the acute cohort, left hip BMD fell by mean ~ 15% by 48 months. Left distal femoral and proximal tibial BMD declined by mean ~ 6-13% at 12 months and ~ 20-23% at 48 months, with a tendency towards greater BMD loss in motor-complete TSCI. A single early ZOL infusion in acute TSCI could not attenuate rapidly declining hip and knee BMD. Prospective controlled studies are required to establish the optimal strategy for preventing early bone loss after acute TSCI.

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC11531416PMC
http://dx.doi.org/10.1007/s00223-024-01292-3DOI Listing

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