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Zoledronic acid administration failed to prevent bone loss at the knee in persons with acute spinal cord injury: an observational cohort study

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Abstract

After acute spinal cord injury (SCI), rapid depletion of the sublesional skeleton occurs, particularly at the distal femur and proximal tibia. Subsequently, fragility fractures of the knee may occur. We determined the efficacy of zoledronic acid to prevent sublesional bone mineral density (BMD) loss at 6 and 12 months after acute SCI. Thirteen subjects with acute motor-complete SCI were prospectively studied: 6 patients received zoledronic acid (5 mg) and 7 subjects did not receive the drug (controls). Zoledronic acid was administered intravenously within 16 weeks of acute injury. Areal BMD was performed by dual energy X-ray absorptiometry at baseline, 6, and 12 months after administration of drug. The treatment group demonstrated sparing of BMD at the total hip at month 6 (p < 0.0006) and at month 12 (p < 0.01). In contrast to the findings at the hip, the treatment group had a greater loss of BMD compared to the control group at the distal femur and proximal tibia at month 6 (−7.9 % ± 3.4 vs.−2.7 % ± 5.0, respectively, p = 0.054; and −10.5 % ± 6.4 vs. −4.8 % ± 6.8, respectively, p = NS) and at month 12 (−18.5 % ± 3.9 vs. −8.4 % ± 7.2, respectively, p = 0.01; and −20.4 % ± 8.8 vs.−7.9 % ± 12.3, respectively, p = 0.06). A single dose of zoledronic acid administered soon after acute SCI reduced the %BMD loss at the hip, but appeared to have no effect to prevent %BMD loss at the knee, the site where fracture risk is greatest in persons with SCI.

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Acknowledgments

The authors would like to thank the James J. Peters Veterans Affairs Medical Center, Bronx, NY, Department of Veterans Affairs Rehabilitation Research & Development Service, and Kessler Institute for Rehabilitation, West Orange, NJ, for their support to perform this work. Novartis Pharmaceuticals Corporation provided drug gratis to perform this clinical trial. This work was funded by a Rehabilitation Research & Development Center of Excellence for the Medical Consequences of Spinal Cord Injury grant (#B9212-C, B4162-C). Veteran Affairs Rehabilitation Research and Development Service (#B9212-C, #B4162-C) and the James J. Peters Veterans Affairs Medical Center. Novartis Pharmaceuticals graciously provided zoledronic acid (Reclast 5 mg) for use in our clinical trial.

Conflicts of interest

The author has no conflicts of interest to declare.

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Authors and Affiliations

  1. VA RR&D National Center of Excellence for the Medical Consequences of Spinal Cord Injury, James J. Peters VA Medical Center, 130 West Kingsbridge Road, Bronx, NY, 10468, USA

    William A. Bauman, Christopher M. Cirnigliaro, Michael F. La Fountaine & Ann M. Spungen

  2. Medical Service, James J. Peters VA Medical Center, Bronx, NY, USA

    William A. Bauman & Ann M. Spungen

  3. Departments of Medicine and Rehabilitation Medicine, The Icahn School of Medicine at Mount Sinai, New York, NY, USA

    William A. Bauman, Michael F. La Fountaine & Ann M. Spungen

  4. Department of Physical Therapy, School of Health and Medical Sciences, Seton Hall University, South Orange, NJ, USA

    Michael F. La Fountaine

  5. Kessler Institute for Rehabilitation, West Orange, NJ, USA

    LeighAnn Martinez & Steven C. Kirshblum

  6. Department of Physical Medicine and Rehabilitation, University of Medicine and Dentistry of New Jersey, Newark, NJ, USA

    Steven C. Kirshblum

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  1. William A. Bauman
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  2. Christopher M. Cirnigliaro
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  3. Michael F. La Fountaine
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  5. Steven C. Kirshblum
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  6. Ann M. Spungen
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Correspondence to William A. Bauman.

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Bauman, W.A., Cirnigliaro, C.M., La Fountaine, M.F. et al. Zoledronic acid administration failed to prevent bone loss at the knee in persons with acute spinal cord injury: an observational cohort study. J Bone Miner Metab 33, 410–421 (2015). https://doi.org/10.1007/s00774-014-0602-x

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  • DOI: https://doi.org/10.1007/s00774-014-0602-x

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