Mun Sojeong, Chalasani Roopa, Van de Vel Gilles, Shukla Pranav S, Zia Shahab Ud Din, Mohammed Lubna
Physical Medicine and Rehabilitation, Hallym University College of Medicine, Chuncheon, KOR.
Research, Wake Forest Institute for Regenerative Medicine, Winston-Salem, USA.
Cureus. 2025 Jun 11;17(6):e85755. doi: 10.7759/cureus.85755. eCollection 2025 Jun.
Spinal cord injury (SCI) causes significant bone loss as a long-term complication, increasing fracture risk and healthcare costs. Bisphosphonates are widely studied for mitigating bone loss since they can prevent fractures and preserve rehabilitation potential in acute SCI patients. Zoledronic acid, in particular, stands out due to its high potency, dosing convenience, and better patient adherence. This review aims to evaluate the efficacy of bisphosphonates, particularly zoledronic acid, in mitigating bone loss in acute SCI. A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines using PubMed, ScienceDirect, PubMed Central (PMC), Google Scholar, and Cochrane Central Register of Controlled Trials (CENTRAL) databases. Studies from January 1, 2016, to December 31, 2024, on bisphosphonate use within six months of SCI were included. Randomized controlled trials using zoledronic acid as the intervention and meta-analyses or systematic reviews covering all bisphosphonates were selected based on predefined inclusion and exclusion criteria. Eight studies, comprising three meta-analyses and five randomized controlled trials with 729 participants, were selected after quality assessment using Assessment of Multiple Systematic Reviews 2 (AMSTAR 2) and a revised Cochrane risk of bias tool for randomized trials (RoB 2). Seven studies demonstrated significant bone mineral density (BMD) improvements at the total hip, four at the lumbar spine, two at the trochanter, and five at the femoral neck. Two meta-analyses performed subgroup analyses of zoledronic acid, demonstrating substantial bone loss reduction, although comparisons with other bisphosphonates were lacking. Reductions in bone resorption markers, such as C-terminal telopeptide (CTX), were observed in five studies. While zoledronic acid exhibits strong anti-resorptive effects and allows for practical intravenous administration, its limited impact on bone formation markers, such as P1NP, and inconsistent BMD improvements across skeletal sites require further investigation. Future studies should assess long-term outcomes, utilize advanced imaging techniques, and directly compare zoledronic acid with other bisphosphonates.
脊髓损伤（SCI）作为一种长期并发症会导致显著的骨质流失，增加骨折风险并提高医疗成本。双膦酸盐类药物因其能够预防骨折并保留急性脊髓损伤患者的康复潜力，故而被广泛研究用于减轻骨质流失。尤其是唑来膦酸，因其高效能、给药方便以及患者依从性更好而备受关注。本综述旨在评估双膦酸盐类药物，特别是唑来膦酸，在减轻急性脊髓损伤骨质流失方面的疗效。按照系统评价与Meta分析的首选报告项目（PRISMA）2020指南，使用PubMed、ScienceDirect、PubMed Central（PMC）、谷歌学术以及Cochrane对照试验中央注册库（CENTRAL）数据库进行了一项系统评价。纳入了2016年1月1日至2024年12月31日期间关于脊髓损伤后六个月内使用双膦酸盐类药物的研究。根据预先定义的纳入和排除标准，选择了以唑来膦酸作为干预措施的随机对照试验以及涵盖所有双膦酸盐类药物的Meta分析或系统评价。在使用多重系统评价评估2（AMSTAR 2）和修订后的随机试验Cochrane偏倚风险工具（RoB 2）进行质量评估后，选择了八项研究（包括三项Meta分析和五项随机对照试验，共729名参与者）。七项研究表明全髋关节的骨矿物质密度（BMD）有显著改善，四项研究表明腰椎有改善，两项研究表明转子部位有改善，五项研究表明股骨颈有改善。两项Meta分析对唑来膦酸进行了亚组分析，显示骨质流失显著减少，不过缺乏与其他双膦酸盐类药物的比较。在五项研究中观察到骨吸收标志物如C末端肽（CTX）的减少。虽然唑来膦酸具有强大的抗吸收作用且允许进行实际的静脉给药，但其对骨形成标志物如I型前胶原氨基端前肽（P1NP）的影响有限，并且在不同骨骼部位的骨矿物质密度改善情况不一致，这需要进一步研究。未来的研究应评估长期结果，采用先进的成像技术，并直接将唑来膦酸与其他双膦酸盐类药物进行比较。
