Original Article

Osteoporosis International

, Volume 22, Issue 1, pp 271-279

First online:

Early treatment with zoledronic acid prevents bone loss at the hip following acute spinal cord injury

  • J. S. BubbearAffiliated withMetabolic Unit, Royal National Orthopaedic Hospital Email author 
  • , A. GallAffiliated withSpinal Cord Injuries Centre, Royal National Orthopaedic Hospital
  • , F. R. I. MiddletonAffiliated withSpinal Cord Injuries Centre, Royal National Orthopaedic Hospital
  • , M. Ferguson-PellAffiliated withFaculty of Rehabilitation Medicine, University of Alberta
  • , R. SwaminathanAffiliated withDepartment of Chemical Pathology, St Thomas’s Hospital
  • , R. W. KeenAffiliated withMetabolic Unit, Royal National Orthopaedic HospitalInstitute of Orthopaedic and Musculoskeletal Science, University College Hospital

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Osteoporosis after spinal cord injury is common. Reductions in bone density are rapid and fracture rates are higher after injury. Early treatment with 4 mg zoledronic acid significantly reduced bone loss at the hip compared to untreated individuals in the first year. Treatment appeared safe and well tolerated.


Bone mineral density (BMD) is lost rapidly following spinal cord injury (SCI), predominantly in the lower limbs. Bone turnover markers suggest an early increase in resorption.


A randomised, open-label study of 14 patients with acute SCI randomised to receive 4 mg IV zoledronic acid or standard treatment. BMD was measured by dual-X-ray absorptiometry at the lumbar spine and hip (femoral neck, total and trochanter) at baseline, 3, 6 and 12 months. Bone turnover markers (serum C-terminal telopeptide and Procollagen I N-terminal peptide and urinary N-terminal telopeptide/Cr ratio) were also measured.


After 12 months, there was a significant difference in BMD between the groups at the total hip (12.4%, p = 0.005), trochanter (13.4%, p = 0.028) and lumbar spine (2.7%, p = 0.033). However, the difference between groups at the femoral neck was not significant (4.8%, p = 0.741). In the treated group, bone resorption was reduced and remained reduced up to 12 months. Other than flu-like symptoms immediately after the infusion, no adverse events were observed.


IV zoledronic acid is an effective and well-tolerated treatment to prevent bone mineral density loss at the total hip and trochanter for up to 12 months following SCI.


Bisphosphonate Osteoporosis Spinal cord injury Zoledronic acid