唑来膦酸可减轻急性脊髓损伤患者前臂的早期骨质流失。
Zoledronic Acid Attenuates Early Bone Loss at Forearm in Patients with Acute Spinal Cord Injury.
作者信息
Goenka Sunil, Sethi Satyaranjan
机构信息
Department of Physical Medicine and Rehabilitation, Sawai Man Singh Medical College, Jaipur, Rajasthan 3020004 India.
出版信息
Indian J Orthop. 2020 Jun 2;54(Suppl 1):127-133. doi: 10.1007/s43465-020-00158-8. eCollection 2020 Sep.
STUDY DESIGN
Randomized controlled trial.
OBJECTIVES
To study the magnitude of bone loss at forearm in persons with acute spinal cord injury (SCI) & the effect of early administration of Zoledronic acid on its' prevention.
SETTINGS
Sawai Man Singh Medical College, Jaipur, India.
METHODS
Sixty patients with acute SCI were randomized either to receive standard medical and nursing care or Zoledronic acid infusion in combination with standard medical and nursing care. Areal bone mineral density (aBMD) was measured at the forearm (radius + ulna) once patients were medically stable using Dual Energy X-Ray Absorptiometry (DXA) at baseline and at 3, 6 and 12 months.
RESULTS
Significant differences in aBMD was found between the control & Zoledronic acid group at 1/3 forearm (- 0.064; 95% CI - 0.092 to - 0.036, = 0.001), mid forearm (- 0.059; 95% CI - 0.084 to - 0.034, = 0.001), UD forearm (- 0.048; 95% CI - 0.097 to 0.001, = 0.016) and total forearm (- 0.048; 95% CI - 0.088 to - 0.008, = 0.021) at 1 year in the paraplegic patients with SCI. Similar significant difference was also observed at 1/3 forearm (- 0.046; 95% CI - 0.073 to - 0.019, = 0.002), mid forearm (- 0.063; 95% CI - 0.088 to - 0.037, < 0.0001), UD forearm (- 0.084; 95% CI - 0.101 to - 0.067, < 0.0001) and total forearm (- 0.115; 95% CI - 0.132 to - 0.097, < 0.0001) respectively at 1 year in the quadriplegic patients with SCI. Significant differences in aBMD between the groups at 6 months post infusion was also observed at these sites in quadriplegic patients. [1/3 forearm - 0.022; 95% CI - 0.039 to - 0.005; = 0.015, Mid forearm - 0.023; 95% CI - 0.042 to - 0.004; = 0.019, UD forearm - 0.041; 95% CI - 0.055 to - 0.027; < 0.0001 and Total forearm - 0.049; 95%CI - 0.062 to - 0.036; < 0.0001]. Bone loss was reduced in the Zoledronic acid treated group compared to the standard treatment group in both paraplegic and quadriplegic patients.
CONCLUSION
Single dose of 5mg intravenous Zoledronic acid is an effective treatment in preventing bone loss at the forearm for 12 months following acute spinal cord injury.
研究设计
随机对照试验。
目的
研究急性脊髓损伤（SCI）患者前臂骨量丢失的程度以及早期给予唑来膦酸对其预防作用的效果。
研究地点
印度斋浦尔的萨瓦伊·曼·辛格医学院。
方法
60例急性SCI患者被随机分为两组，一组接受标准医疗和护理，另一组接受唑来膦酸输注联合标准医疗和护理。患者病情稳定后，使用双能X线吸收法（DXA）在基线、3个月、6个月和12个月时测量前臂（桡骨+尺骨）的面积骨密度（aBMD）。
结果
在SCI截瘫患者中，1年后对照组与唑来膦酸组在前臂1/3处（-0.064；95%可信区间-0.092至-0.036，P=0.001）、前臂中部（-0.059；95%可信区间-0.084至-0.034，P=0.001）、尺桡骨远端（-0.048；95%可信区间-0.097至0.001，P=0.016）和整个前臂（-0.048；95%可信区间-0.088至-0.008，P=0.021）的aBMD存在显著差异。在SCI四肢瘫患者中，1年后在前臂1/3处（-0.046；95%可信区间-0.073至-0.019，P=0.002）、前臂中部（-0.063；95%可信区间-0.088至-0.037，P<0.0001）、尺桡骨远端（-0.084；95%可信区间-0.101至-0.067，P<0.0001）和整个前臂（-0.115；95%可信区间-0.132至-0.097，P<0.0001）也观察到类似的显著差异。在四肢瘫患者输注后6个月时，这些部位两组之间的aBMD也存在显著差异。[前臂1/3处-0.022；95%可信区间-0.039至-0.005；P=0.015，前臂中部-0.023；95%可信区间-0.042至-0.004；P=0.019，尺桡骨远端-0.041；95%可信区间-0.055至-0.027；P<0.0001，整个前臂-0.049；95%可信区间-0.062至-0.036；P<0.0001]。与标准治疗组相比，唑来膦酸治疗组的截瘫和四肢瘫患者骨量丢失均减少。
结论
单次静脉注射5mg唑来膦酸是预防急性脊髓损伤后12个月前臂骨量丢失的有效治疗方法。
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