Preventing OsteoPorosis in Spinal Cord Injury (POPSCI) Study—Early Zoledronic Acid Infusion in Patients with Acute Spinal Cord Injury

Calcified Tissue International, 2024 · DOI: 10.1007/s00223-024-01292-3 · Published: September 25, 2024

Spinal Cord Injury Endocrinology Musculoskeletal Medicine

Simple Explanation

This study investigated bone loss after spinal cord injury (SCI) and the effect of zoledronic acid (ZOL) treatment. Two groups were studied: one with recent SCI who received ZOL, and another with longer-term SCI who did not. The study found that early ZOL treatment did not prevent bone loss in the hip and knee, and that more severe SCI may lead to worse bone outcomes.

Study Duration

4 years

Participants

20 (11 acute TSCI, 9 chronic TSCI)

Evidence Level

Not specified

Key Findings

1
Acute TSCI patients had higher bone turnover markers and sclerostin concentrations at baseline compared to chronic TSCI patients.
2
Despite early ZOL infusion, acute TSCI patients experienced rapid hip and knee BMD losses over 4 years.
3
Motor-complete TSCI may predict a worse knee BMD response to ZOL.

Research Summary

This study evaluated the impact of early zoledronic acid (ZOL) infusion on bone mineral density (BMD) in acute traumatic spinal cord injury (TSCI) patients compared to chronic TSCI patients. The findings indicated that despite early ZOL administration, acute TSCI patients experienced significant BMD loss in the hip and knee over a 4-year period. The study suggests that a single ZOL infusion may not be sufficient to prevent bone loss and that motor-complete TSCI may be associated with a poorer response to ZOL in terms of knee BMD.

Practical Implications

Treatment Strategies

Current osteoporosis treatment strategies may be inadequate for preventing bone loss after acute TSCI.

Risk Stratification

Motor-complete SCI patients may require more intensive early intervention.

Knee BMD Monitoring

Longitudinal knee BMD assessment is crucial in TSCI studies.

Study Limitations

1
Lack of a direct control group for the acute interventional TSCI cohort.
2
Limited participant recruitment due to the COVID-19 pandemic and geographical barriers.
3
Instances of missed BMD assessments, limiting power in longitudinal and subgroup analyses.

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