Bisphosphonate use in acute and chronic spinal cord injury: a systematic review.
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.
Bryson
Julia E
JE
Department of Physical Medicine and Rehabilitation, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina 27517, USA. jb@juliabryson.com
Gourlay
Margaret L
ML
D050071:Bone Density Conservation Agents / Q000627:therapeutic use*; D004164:Diphosphonates / Q000627:therapeutic use*; D006801:Humans; D016239:MEDLINE / Q000706:statistics & numerical data; D039781:PubMed / Q000706:statistics & numerical data; D013119:Spinal Cord Injuries / Q000188:drug therapy*
D050071:Bone Density Conservation Agents; D004164:Diphosphonates