Effect of early treatment with zoledronic acid on prevention of bone loss in patients with acute spinal cord injury – Hospital-based randomised controlled study

Abstract

Osteoporosis following spinal cord injury is well known and is indicated by low bone mass with deterioration of skeletal micro-architecture. Decrease in bone mineral density is early & rapid and incidence of osteoporotic/fragility fractures are higher after injury. Early treatment with Zoledronic acid significantly reduces bone loss as compared to untreated individuals. A hospital based randomized prospective interventional open label study wherein sixty patients with acute spinal cord injury were randomized to receive either standard treatment alone or along with Zoledronic acid. BMD was measured at hip by Dual Energy X-Ray Absorptiometry at baseline, 3, 6 and 12 months. Variables thus obtained were subjected to statistical analysis. Significant difference in BMD was observed between the groups at 12 months at neck of femur (0.729 ± 0.085 vs 0.806 ± 0.102, P = 0.003), trochanter (0.546 ± 0.068 vs 0.663 ± 0.091, P < 0.001), intertrochanter (0.796 ± 0.106 vs 0.955 ± 0.149, P < 0.001) and total hip (0.734 ± 0.074 vs 0.845 ± 0.125, P < 0.001). Similar significant difference in BMD between the groups was also observed at forearm in quadriplegic as well as paraplegic patients. In the treated group, bone resorption was reduced and remained reduced for up to 12 months. Zoledronic acid (5 mg/100 mL) infusion prevents significant bone loss for 1 year at hip and forearm in patients following acute spinal cord injury and is well tolerated.