Soleyman-Jahi Saeed, Yousefian Ali, Maheronnaghsh Radin, Shokraneh Farhad, Zadegan Shayan Abdollah, Soltani Akbar, Hosseini Seyed Mostafa, Vaccaro Alexander R, Rahimi-Movaghar Vafa
Universal Scientific, Educational, and Research Network (USERN), Tehran University of Medical Sciences, Tehran, Iran.
Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran.
Eur Spine J. 2018 Aug;27(8):1798-1814. doi: 10.1007/s00586-017-5114-7. Epub 2017 May 11.
Spinal cord injury (SCI) results in accelerated bone mineral density (BMD) loss and disorganization of trabecular bone architecture. The mechanisms underlying post-SCI osteoporosis are complex and different from other types of osteoporosis. Findings of studies investigating efficacy of pharmacological or rehabilitative interventions in SCI-related osteoporosis are controversial. The aim of this study was to review the literature pertaining to prevention and evidence-based treatments of SCI-related osteoporosis.
In this systematic review, MEDLINE, EMBASE, PubMed, and the Cochrane Library were used to identify papers from 1946 to December 31, 2015. The search strategy involved the following keywords: spinal cord injury, osteoporosis, and bone loss.
Finally, 56 studies were included according to the inclusion criteria. Only 16 randomized controlled trials (involving 368 patients) were found. We found following evidences for effectiveness of bisphosphonates in prevention of BMD loss in acute SCI: very low-quality evidence for clodronate and etidronate, low-quality evidence for alendronate, and moderate-quality evidence for zoledronic acid. Low-quality evidence showed no effectiveness for tiludronate. In chronic SCI cases, we found low-quality evidence for effectiveness of vitamin D analogs combined with 1-alpha vitamin D. However, low-quality inconsistent evidence exists for alendronate. For non-pharmacologic interventions, very low-quality evidence exists for effectiveness of standing with or without treadmill walking in acute SCI. Other low-quality evidences indicated that electrical stimulation, tilt-table standing, and ultrasound provide no significant effects. Very low-quality evidence did not show any benefit for low-intensity (3 days per week) cycling with functional electrical stimulator in chronic SCI.
No recommendations can be made from this review, regarding overall low quality of evidence as a result of high risk of bias, low sample size in most of the studies, and notable heterogeneity in type of intervention, outcome measurement, and duration of treatment. Therefore, future high-quality RCT studies with higher sample sizes and more homogeneity are strongly recommended to provide high-quality evidence and make applicable recommendations for prevention and treatment of SCI-related bone loss.
脊髓损伤（SCI）会导致骨矿物质密度（BMD）加速流失以及小梁骨结构紊乱。SCI后骨质疏松的潜在机制复杂，与其他类型的骨质疏松不同。研究药物或康复干预对SCI相关骨质疏松疗效的研究结果存在争议。本研究的目的是回顾与SCI相关骨质疏松的预防和循证治疗相关的文献。
在这项系统评价中，使用MEDLINE、EMBASE、PubMed和Cochrane图书馆来识别1946年至2015年12月31日期间的论文。检索策略涉及以下关键词：脊髓损伤、骨质疏松症和骨质流失。
最终，根据纳入标准纳入了56项研究。仅发现16项随机对照试验（涉及368名患者）。我们发现以下双膦酸盐预防急性SCI中BMD流失有效性的证据：氯膦酸盐和依替膦酸盐的证据质量极低，阿仑膦酸盐的证据质量低，唑来膦酸的证据质量中等。低质量证据表明替鲁膦酸盐无效。在慢性SCI病例中，我们发现维生素D类似物联合1-α维生素D有效性的证据质量低。然而，阿仑膦酸盐存在低质量的不一致证据。对于非药物干预，急性SCI中站立加或不加跑步机行走有效性的证据质量极低。其他低质量证据表明电刺激、倾斜台站立和超声无显著效果。极低质量证据未显示慢性SCI中使用功能性电刺激器进行低强度（每周3天）骑自行车有任何益处。
由于存在偏倚风险高、大多数研究样本量小以及干预类型、结局测量和治疗持续时间存在显著异质性等问题，本次综述无法给出建议。因此，强烈建议未来开展样本量更大、同质性更高的高质量随机对照试验，以提供高质量证据，并对SCI相关骨质流失的预防和治疗提出适用建议。
