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Critical Reviews™ in Physical and Rehabilitation Medicine
SJR: 0.121 SNIP: 0.228 CiteScore™: 0.5

ISSN Print: 0896-2960
ISSN Online: 2162-6553

Critical Reviews™ in Physical and Rehabilitation Medicine

DOI: 10.1615/CritRevPhysRehabilMed.2016018768
pages 85-93

Effect of Zoledronic Acid on Osteoporosis after Chronic Spinal Cord Injury: A Randomized Controlled Trial

Shiela Mary Varghese
Caritas Hospital, Kottayam, Kerala, India
Bobeena Chandy
Department of Physical Medicine and Rehabilitation, Christian Medical College Vellore, Tamil Nadu, India
Raji Thomas
Department of Physical Medicine and Rehabilitation, Christian Medical College, Vellore, Tamil Nadu, India, 632004
George Tharion
Department of Physical Medicine and Rehabilitation, Christian Medical College, Vellore, Tamil Nadu, India

ABSTRACT

This was a double-blind, randomized, placebo-controlled parallel-group pilot trial to observe the effect of single-dose zoledronic acid on bone mineral density (BMD) in persons with chronic spinal cord injury (SCI). Twenty-eight subjects with traumatic SCI, at least 1 year after trauma who had osteoporosis were randomized to receive either intervention or placebo. The intervention consisted of a single dose of intravenous zoledronic acid (Zoldonat) 4 mg in 100 ml of normal saline infused over 20 minutes. The placebo group received 100 ml of normal saline infusion. BMD of hip and forearm was measured by dual-energy x-ray absorptiometry (DEXA) at baseline and 1 year after intervention. A nonparametric test, the Wilcoxon signed-rank test, was used to evaluate the postintervention change in BMD. BMD of distal forearm showed a statistically significant rise in both groups after intervention (p = 0.004 in placebo group, p = 0.004 in zoledronic acid group). At 1 year, BMD of total hip in the placebo group showed a statistically significant reduction (p = 0.017), whereas that the zoledronic acid group did not show a statistically significant reduction (p = 0.082). BMD of femoral neck showed a statistically significant reduction in both groups (p = 0.002 in the placebo group; p = 0.044 in the zoledronic acid group). However, the magnitude of decrease was greater in placebo recipients. We conclude that a single dose of zoledronic acid partially prevents ongoing reduction in BMD at total hip but not at femoral neck in patients with chronic SCI.


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