Biering-Sørensen F, Hansen B, Lee B S B
Clinic for Spinal Cord Injuries, Rigshospitalet, Hornbaek, Denmark.
Spinal Cord. 2009 Jul;47(7):508-18. doi: 10.1038/sc.2008.177. Epub 2009 Jan 27.
Review the literature on non-pharmacological prevention and treatment of osteoporosis after spinal cord injury (SCI).
PubMed, EMBASE and the Cochrane Controlled Trials Register were searched. All identified papers were read by title, abstract and full-length article when relevant. Hand search of the articles' sources identified additional papers. For included studies, the level of evidence was determined.
No studies conclusively showed an effective intervention. However, there are few randomized controlled trials (RCTs), and those that exist assess interventions and outcome measures that could be improved. Five studies on weight-bearing early post-injury are conflicting, but standing or walking may help retain bone mineral. In the chronic phase, there was no effect of weight bearing (12 studies). One study found that an early commencement of sports after SCI improved bone mineral, and the longer the period of athletic career, the higher the (leg) bone mineral. Early after SCI, there may be some effects of electrical stimulation (ES) (five studies). Chronic-phase ES studies vary (14 studies, including mixed periods after injury), but improvement is seen with longer period of training, or higher frequency or stimulus intensity. Improvements correspond to trabecular bone in the distal femur or proximal tibia. Impact vibration and pulsed electromagnetic fields may have some positive effects, whereas pulsed ultrasound does not. Six studies on the influence of spasticity show inconsistent results.
Bone mineral should be measured around the knee; the length and intensity of the treatment should be sufficiently long and high, respectively, and should commence early after SCI. If bone mineral is to remain, the stimulation has to be possibly continued for long term. In addition, RCTs are necessary.
回顾关于脊髓损伤（SCI）后骨质疏松症非药物预防和治疗的文献。
检索了PubMed、EMBASE和Cochrane对照试验注册库。所有检索到的论文在相关时均通过标题、摘要和全文进行阅读。通过手工检索文章来源确定了其他论文。对于纳入的研究，确定了证据水平。
没有研究确凿地表明有有效的干预措施。然而，随机对照试验（RCT）很少，现有的那些试验评估的干预措施和结局指标还有待改进。五项关于损伤后早期负重的研究结果相互矛盾，但站立或行走可能有助于保留骨矿物质。在慢性期，负重没有效果（12项研究）。一项研究发现，SCI后早期开始运动可改善骨矿物质，运动生涯时间越长，（腿部）骨矿物质越高。SCI后早期，电刺激（ES）可能有一些效果（五项研究）。慢性期ES研究结果不一（14项研究，包括损伤后的混合时间段），但训练时间更长、频率更高或刺激强度更大时可见改善。改善对应于股骨远端或胫骨近端的小梁骨。冲击振动和脉冲电磁场可能有一些积极作用，而脉冲超声则没有。六项关于痉挛影响的研究结果不一致。
应测量膝关节周围的骨矿物质；治疗的时长和强度应分别足够长和足够高，并应在SCI后尽早开始。如果要保留骨矿物质，刺激可能必须长期持续。此外，随机对照试验是必要的。
