Zoledronic acid after spinal cord injury mitigates losses in proximal femoral strength independent of ambulation ability.

Autor: Crack LE; Human Performance Lab, Faculty of Kinesiology, University of Calgary, Alberta, Canada. laura.crack@ucalgary.ca.; McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Alberta, Canada. laura.crack@ucalgary.ca., Haider IT; Human Performance Lab, Faculty of Kinesiology, University of Calgary, Alberta, Canada.; McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Alberta, Canada., Simonian N; Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL, USA., Barroso J; Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL, USA., Gabel L; Human Performance Lab, Faculty of Kinesiology, University of Calgary, Alberta, Canada.; McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Alberta, Canada., Schnitzer TJ; Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL, USA., Edwards WB; Human Performance Lab, Faculty of Kinesiology, University of Calgary, Alberta, Canada.; McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Alberta, Canada.; Department of Biomedical Engineering, Schulich School of Engineering, University of Calgary, Alberta, Canada.
Jazyk: angličtina
Zdroj: Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA [Osteoporos Int] 2023 Sep; Vol. 34 (9), pp. 1637-1645. Date of Electronic Publication: 2023 Jun 08.
DOI: 10.1007/s00198-023-06811-w
Abstrakt: Rapid bone loss can occur after spinal cord injury (SCI) and a standard of care to prevent or treat this phenomenon is an active area of research. Using advanced analysis techniques, this study demonstrates that zoledronic acid, a possible treatment, prevented loss of bone strength at the hip following SCI.
Introduction: Bone loss below the level of neurological lesion is a well-known complication of spinal cord injury (SCI), and effective preventive treatment for this phenomenon is an active area of research. Zoledronic acid has demonstrated efficacy to attenuate bone loss at the hip after SCI, but previous studies relied on measurements from dual-energy X-ray absorptiometry. The purpose of this investigation was to more thoroughly characterize changes to bone mineral and strength at the proximal femur in individuals receiving zoledronic acid in the acute SCI stage; we also examined the influence of ambulatory ability on bone outcomes.
Methods: Participants randomized to either zoledronic acid (n = 29) or placebo (n = 30) received computed tomography (CT) scans and ambulatory assessments at baseline and 6 and 12 months following drug infusion. CT-based finite element (FE) modeling was used to predict changes in proximal femoral strength associated with treatment.
Results: After 12 months, FE-predicted bone strength was reduced by a mean (SD) of 9.6 (17.9)% in the zoledronic acid group versus 24.6 (24.5)% in the placebo group (p = 0.007). These differences in strength were explained by reductions in CT measurements of both trabecular (p < 0.001) and cortical (p ≤ 0.021) bone at the femoral neck and trochanteric region. Ambulation ability influenced select trabecular and cortical parameters, but we were unable to detect an impact on FE-predicted bone strength.
Conclusion: These findings demonstrate that treatment with zoledronic acid in acute SCI attenuates losses in proximal femoral strength, which may reduce the risk of hip fractures across patients with varying degrees of ambulatory abilities.
(© 2023. International Osteoporosis Foundation and Bone Health and Osteoporosis Foundation.)
Databáze: MEDLINE
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