Crack Laura E, Haider Ifaz T, Simonian Narina, Barroso Joana, Gabel Leigh, Schnitzer Thomas J, Edwards W Brent
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.
Osteoporos Int. 2023 Sep;34(9):1637-1645. doi: 10.1007/s00198-023-06811-w. Epub 2023 Jun 8.
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.
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.
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.
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.
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.
脊髓损伤（SCI）后可迅速发生骨质流失，预防或治疗这一现象的标准护理方法是一个活跃的研究领域。本研究使用先进的分析技术表明，唑来膦酸作为一种可能的治疗方法，可预防SCI后髋部骨强度的丧失。
神经损伤水平以下的骨质流失是脊髓损伤（SCI）的一种众所周知的并发症，针对这一现象的有效预防性治疗是一个活跃的研究领域。唑来膦酸已被证明可减轻SCI后髋部的骨质流失，但以往的研究依赖于双能X线吸收法的测量。本研究的目的是更全面地描述急性SCI阶段接受唑来膦酸治疗的个体股骨近端骨矿物质和强度的变化；我们还研究了行走能力对骨骼结果的影响。
随机分为唑来膦酸组（n = 29）或安慰剂组（n = 30）的参与者在基线、药物输注后6个月和12个月接受计算机断层扫描（CT）和行走能力评估。基于CT的有限元（FE）建模用于预测与治疗相关的股骨近端强度变化。
12个月后，唑来膦酸组FE预测的骨强度平均（标准差）降低了9.6（17.9）%，而安慰剂组为24.6（24.5）%（p = 0.007）。这些强度差异是由股骨颈和转子区小梁骨（p < 0.001）和皮质骨（p ≤ 0.021）的CT测量值降低所解释的。行走能力影响了选定的小梁骨和皮质骨参数，但我们未能检测到对FE预测的骨强度的影响。
这些发现表明，急性SCI患者使用唑来膦酸治疗可减轻股骨近端强度的损失，这可能降低不同程度行走能力患者髋部骨折的风险。
