Prevention and treatment of osteoporosis after spinal cord injury: A systematic review

Abstract

Spinal cord induced osteoporosis is a significant health condition associated with fragility fractures beneath the level of injury. In the scientific literature several treatment options have been proposed. The aim of this paper is to review the current literature about treatments’ efficacy for osteoporosis in spinal cord injury. A systematic literature search is conducted in four electronic databases: PubMed, Embase, The Cochrane Library and PEDro. All identified records are analysed by title, abstract and if relevant by full text to determine if they meet all inclusion criteria. Additionally, the included RCTs are judged to a quality control according to the Cochrane Handbook for Systematic Reviews of Interventions, Risk of Bias Assessment. Due to the heterogeneity of the included trials no meta-analysis is performed. Thirty-two randomized controlled trials are included. Bisphosphonate therapy, if applied correctly, is effective to optimize bone quality, in both the early and chronic phase of the disease, although the evidence is debatable. Moderate-quality evidence suggests that intravenous administration of zoledronic acid is potentially the best approach to tackle this condition. Rehabilitation techniques, although widely used, show no proven efficacy on this matter. In addition, numerous experimental therapies have been proposed, but require further research to prove their applicability. This systematic review suggests that bisphosphonate administration could attenuate sublesional bone loss, while we did not find conclusive evidence about various rehabilitation techniques. Although this paper does not provide final evidence, it could be a useful tool for future research purposes.