Treatment of osteoporosis in patients with spinal cord injury
Keywords:spinal cord injury, osteoporosis, dual energy X-ray absorptiometry, calcium, vitamin D, ibandronic acid
Background. Osteoporosis is a well-known complication of spinal cord injury (SCI). Significance of this problem grows proportionally to the social adaptation of para- and tetraplegic patients. The purpose of the study was to evaluate the effectiveness of the combined treatment for SCI-induced osteoporosis. Materials and methods. Twenty-nine male patients with SCI (AIS A, B) with a duration of post-traumatic period at least 12 months were examined, 17 of whom received comprehensive treatment with calcium, vitamin D and ibandronic acid (group I), and 12 patients, who did not received the prescribed treatment for various reasons (group II). The bone mineral density (BMD) was determined at the total body, lumbar spine and total hip twice (before treatment and 12 months later) by X-ray absorptiometry (X-ray densitometry), which was performed on Prodigy (GE, 2005). Results. It was shown a significant reduction in BMD at the level of total body — by 3.7 % (1.111 ± 0.023 versus 1.005 ± 0.031 g/cm2, respectively; p < 0.05), total hip — by 11.6 % (0.852 ± 0.018 versus 0.756 ± 0.023 g/cm2, respectively; p < 0.05) and lower extremities — by 10.2 % (1.193 ± 0.019 versus 1.061 ± 0.027 g/cm2, respectively; p < 0.05) in patients of group II, who did not receive treatment. BMD in regions of the skeleton located below the level of trauma was stabilized, and BMD at the level of the lumbar spine was significantly increased by 5.6 % (1.097 ± 0.022 versus 1.158 ± 0.019 g/cm2, respectively; p < 0.05) in group I as a result of the treatment. Conclusions. The comprehensive therapy in patients with SCI-induced osteoporosis made it possible to reduce the loss of BMD of the lower extremities and the risk of fractures due to low-energy trauma that can improve the rehabilitation possibilities and quality of life in patients with SCI. The proposed method for treating SCI-induced osteoporosis is effective and safe, which allows it to be recommended for use in clinical practice.
Bauman W, Cardozo C. Osteoporosis in individuals with spinal cord injury. PM R. 2015 Feb;7(2):188-201; quiz 201. doi: 10.1016/j.pmrj.2014.08.948.
Eser P, Frotzler A, Zehnder Y, et al. Relationship between the duration of paralysis and bone structure: a pQCT study of spinal cord injured individuals. Bone. 2004 May;34(5):869-80. doi: 10.1016/j.bone.2004.01.001.
Troy KL, Morse LR. Measurement of bone: diagnosis of SCI-induced osteoporosis and fracture risk prediction. Top Spinal Cord Inj Rehabil. 2015 Fall;21(4):267-74. doi: 10.1310/sci2104-267.
Carbone L, Chin AS, Lee TA, et al. The association of anticonvulsant use with fractures in spinal cord injury. Am J Phys Med Rehabil. 2013 Dec;92(12):1037-46; quiz 1047-50. doi: 10.1097/PHM.0000000000000014.
Morse LR, Battaglino RA, Stolzmann K, et al. Osteoporotic fractures and hospitalization risk in chronic spinal cord injury. Osteoporos Int. 2009 Mar;20(3):385-92. doi: 10.1007/s00198-008-0671-6.
Charmetant C, Phaner V. Condemine A, Calmels P. Diagnosis and treatment of osteoporosis in spinal cord injury patients: a literature review. Ann Phys Rehabil Med. 2010 Dec;53(10):655-68. doi: 10.1016/j.rehab.2010.10.001.
Bauman W, Spungen A, Morrison N, Zhang R, Schwartz E. Effect of a vitamin D analog on leg bone mineral density in patients with chronic spinal cord injury. J Rehabil Res Dev. 2005 Sep-Oct;42(5):625-34. PMID: 16586188.
Battaglino R, Lazzari A, Garshick E, Morse L. Spinal cord injury-induced osteoporosis: pathogenesis and emerging therapies. Curr Osteoporos Rep. 2012 Dec;10(4):278-85. doi: 10.1007/s11914-012-0117-0.
Chang K, Hung C, Chen W, Lai M, Chien K, Han D. Effectiveness of bisphosphonate analogues and functional electrical stimulation on attenuating post-injury osteoporosis in spinal cord injury patients – a systematic review and meta-analysis. PLoS One. 2013 Nov 22;8(11):e81124. doi: 10.1371/journal.pone.0081124.
Povoroznyuk VV, Balatska NI, Dzerovych NI, Muts VY, Sinenky OV. Sposib indyvidual’noi’ cil’ovoi’ terapii’ deficytu vitaminu D u pacijentiv iz zahvorjuvannjamy kistkovo-m’jazovoi’ systemy [The way of the individual target therapy of vitamin D deficiency in patients with diseases of the musculoskeletal system].Patent UA No 112357, 2006.
Genant HK, Lewiecki EM, Fuerst T, Fries M. Effect of monthly ibandronate on hip structural geometry in men with low bone density. Osteoporos Int. 2012 Jan;23(1):257-65. doi: 10.1007/s00198-011-1732-9.
Soleyman-Jahi S, Yousefian A, Maheronnaghsh R, et al. Evidence-based prevention and treatment of osteoporosis after spinal cord injury: a systematic review. Eur Spine J. 2017 May 11. doi: 10.1007/s00586-017-5114-7. [Epub ahead of print]
Varghese SM, Chandy BR, Thomas R, Tharion G. Effect of zoledronic acid on osteoporosis after chronic spinal cord injury: a randomized controlled trial. Crit Rev Phys Rehabil Med. 2016;28(1-2):85-93. doi: 10.1615/CritRevPhysRehabilMed.2016018768.
How to Cite
Copyright (c) 2017 V.V. Povoroznyuk, M.A. Bystrytska, N.I. Balatska
This work is licensed under a Creative Commons Attribution 4.0 International License.