Association between alendronate, serum alkaline phosphatase level, and heterotopic ossification in individuals with spinal cord injury

The Journal of Spinal Cord Medicine, 2015 · DOI: 10.1179/2045772314Y.0000000213 · Published: January 1, 2015

Spinal Cord Injury Pharmacology Musculoskeletal Medicine

Simple Explanation

Heterotopic ossification (HO) is the formation of bone in soft tissues around joints, often occurring after spinal cord injury (SCI). This study investigates whether alendronate (ALN), a drug used to prevent bone loss, can prevent HO in SCI patients. The study reviewed data from SCI patients who received ALN and those who did not, comparing the occurrence of HO in both groups. The researchers also looked at the relationship between HO, ALN intake, and bone metabolism markers. The results showed that while ALN did not directly prevent HO, abnormal levels of serum alkaline phosphatase (ALP) were more common in patients who developed HO and did not take ALN, suggesting ALN might have a role in HO prevention, especially in those with high ALP levels.

Study Duration

3 Months

Participants

299 patients with SCI

Evidence Level

Level III, Retrospective study

Key Findings

1
There was no statistically significant difference in the incidence of HO in patients receiving oral ALN compared to those not receiving it.
2
A significant correlation was found between abnormal serum alkaline phosphatase (ALP) levels and the appearance of HO.
3
Oral ALN intake was positively correlated with normal serum ALP levels.

Research Summary

This retrospective study investigated the protective effect of oral alendronate (ALN) intake on the appearance of heterotopic ossification (HO) in patients with spinal cord injury (SCI). The study found no direct prevention of HO in patients with SCI by oral ALN intake. However, abnormal serum ALP was found more frequently in patients with HO development and without oral ALN intake. The conclusion suggests that ALN may play a role in preventing HO, especially in patients with acute SCI with increasing levels of serum ALP, though further prospective studies are warranted.

Practical Implications

Monitoring ALP Levels

Regular serum ALP measurements should be conducted in acute SCI patients with HO risk factors.

Potential ALN Prescription

ALN could be prescribed for HO prevention in patients with acute SCI, if not contraindicated, when increasing ALP levels are observed.

Further Research Needed

Prospective randomized trials with controlled patient selection criteria are needed to confirm the preventive effect of oral ALN intake on HO, with bone-specific ALP measurement.

Study Limitations

1
Retrospective design with non-consistent start time or duration of ALN intake
2
Different characteristics between the non-ALN and ALN patient groups
3
Lack of universal use of triple phase bone scan for HO diagnosis, possibly missing subclinical cases

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