Bisphosphonates Alleviate Bone Loss in People with Acute Spinal Cord Injury: A Systematic Review and Meta-Analysis

OBJECTIVE: Bone loss is not to be underestimated in people with acute spinal cord injury (SCI). Bisphospho-nates can inhibit the bone resorption of osteoclast. To study whether the early application of bisphosphonates can alleviate bone loss after acute SCI, we included 7 ran-domized controlled trials for meta-analysis.METHODS: Seven randomized controlled trials were found in literature databases. The percentage change in bone mineral density (BMD) at different sites were primary outcomes and serum bone turnover markers were sec-ondary outcomes. A random-effects model was selected for meta-analysis.RESULTS: There were significant differences in the percentage change in BMD of the lumbar spine, total hip, and femoral neck between the bisphosphonates and con-trol groups, but not in the percentage change in distal fe-mur BMD. Besides, there were no statistically significant differences between the groups in the bone formation marker Procollagen type 1 N propeptide; bisphosphonates were effective in reducing the C-terminal telopeptide at the 6-month follow-up, but not at the 12-month follow-up. Subgroup analysis of the effects of zoledronate showed positive effects on BMD of the lumbar spine, total hip, and femoral neck at the 6-month follow-up and showed positive effects on BMD of the total hip and femoral neck at the 12 -month follow-up.CONCLUSIONS: Bisphosphonates can effectively alle-viate the bone loss of the lumbar spine, total hip, and femoral neck in patients with acute SCI, and early appli-cation is advocated.

Automated summary

In this meta-analysis of 7 randomized controlled trials, bisphosphonates were found to effectively alleviate bone loss in patients with acute spinal cord injury, particularly in the lumbar spine, femoral neck, and total hip. Early application of bisphosphonates is recommended.