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The efficacy and safety of bisphosphonate analogs for treatment of osteoporosis after spinal cord injury: a systematic review and meta-analysis of randomized controlled trials

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Abstract

Summary

Bisphosphonates can inhibit osteoclast-mediated bone resorption, prevent bone loss, and reduce the risk of osteoporotic fractures. Our meta-analysis of studies shows that early bisphosphonate administration after SCI was safe and beneficial to the BMD of the total hip and lumbar spine at 12 months.

Introduction

Rapid bone loss in the early stages of spinal cord injury (SCI) leads to an increased risk of osteoporotic fracture. A meta-analysis was conducted to assess the efficacy and safety of bisphosphonates for the treatment of osteoporosis after SCI.

Methods

A literature search of the PubMed, EMBASE, Cochrane Library, and Web of Science databases identified nine randomized controlled trials with 206 individuals. This meta-analysis was performed using a random-effects model. The primary outcome was the percent change in bone mineral density (BMD) of the total hip, distal femur, and lumbar spine from baseline to 12 months. Bone turnover markers were secondary outcomes. The incidences of adverse events were assessed in order to evaluate safety.

Results

There were significant differences in BMD of the total hip and lumbar spine or serum C-terminal telopeptide between the bisphosphonate and control groups but no difference in adverse events. The percent change in BMD of the distal femur and serum type 1 procollagen N-terminal peptide from baseline to 12 months was not superior in the treatment groups. Osteoclast-mediated bone resorption was inhibited by bisphosphonate administration. Subgroup analyses of participants treated with zoledronate at different sites revealed a beneficial effect on BMD of the total hip and lumbar spine but not the distal femur.

Conclusion

Early bisphosphonate administration after SCI was safe and beneficial to the BMD of the total hip and lumbar spine at 12 months.

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Data availability

All data generated or analyzed during this study are included in published articles, which are available in PubMed, Embase, Web of Science, and Cochrane Library databases [21,22,23,24,25,26,27,28,29].

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Acknowledgments

The authors would like to thank the Department of Spine Surgery, Beijing Bo’ai Hospital, China Rehabilitation Research Center for the generous support and the International Science Editing (http://www.internationalscienceediting.com) for editing this manuscript.

Funding

Projects of China Rehabilitation Research Center (NO.2017ZX-02) and Capital’s Funds for Health Improvement and Research (NO.2018-3-6012) funded this submitted work.

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Authors and Affiliations

  1. School of Rehabilitation Medicine, Capital Medical University, Beijing, China

    Y. Wu, F. Wang & Z. Zhang

  2. Department of Spine and Spinal Cord Surgery, Beijing Bo’ai Hospital, China Rehabilitation Research Center, No. 10, Jiaomen North Road, Fengtai District, Beijing, China

    F. Wang

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Correspondence to F. Wang.

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Wu, Y., Wang, F. & Zhang, Z. The efficacy and safety of bisphosphonate analogs for treatment of osteoporosis after spinal cord injury: a systematic review and meta-analysis of randomized controlled trials. Osteoporos Int 32, 1117–1127 (2021). https://doi.org/10.1007/s00198-020-05807-0

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