Combined Calcitriol-Pamidronate Therapy For Bone Hyperresorption In Spinal Cord Injury

Chen, Bojun; Mechanick, Jeffrey; Nierman, David M.; Stein, Adam

doi:10.1080/10790268.2001.11753580

Cited by 16 publications

(30 citation statements)

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“…nate dosing [10]; P , 0.02), and 22% of patients became hypophosphatemic (,2.5 mg/dL; compared with 53% receiving the 3-day 30-mg pamidronate dosing [10]; P , 0.02). Patients were clinically asymptomatic despite these decreases in serum calcium and phosphate.…”

Section: Resultsmentioning

confidence: 99%

“…In our previous study, combined calcitriol 0.5 lg daily and calcium 1,000 mg daily with 30 mg pamidronate for 3 days significantly reduced NTx levels in patients with SCI, suggesting a beneficial role on bone hyperresorption (10). This pamidronate dose is recommended by the manufacturers of Aredia (pamidronate; Novartis, East Hanover, NJ) in the package insert for the treatment of Paget's disease (30,31) and has also been used previously for bone hyperresorption in the chronically critically ill patient (21).…”

Section: Introductionmentioning

confidence: 80%

“…This is supported by a biochemical profile characterized by increased urinary excretion of N-and C-telopeptide (NTx and CTx; markers of bone resorption) and calcium, suppressed parathyroid hormone (PTH) and 1,25-dihydroxyvitamin D 3 (1,25-D) levels, and decreased osteocalcin levels (a marker of bone formation) as early as 9 to 14 days after SCI (3,4,(10)(11)(12). Subsequently, there is a mild increase in bone formation (13,14), but elevated markers of bone resorption peak at 10 to 16 weeks (14).…”

Section: Introductionmentioning

confidence: 97%

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Effect of a Convenient Single 90-mg Pamidronate Dose on Biochemical Markers of Bone Metabolism in Patients With Acute Spinal Cord Injury

Mechanick

Liu

Nierman

et al. 2006

The Journal of Spinal Cord Medicine

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Background/Objective: To describe the biochemical and adverse effects of a convenient single 90 mg pamidronate dose in patients with acute spinal cord injury (SCI) and compare these effects with those observed in a previous similar study using a 30 mg/d 3 3-day pamidronate dosing regimen.Study Design: Retrospective cohort study.Setting: University-based rehabilitation center in New York City.Methods: A total of 32 patients with SCI were evaluated for biochemical response and adverse events associated with pamidronate therapy. All patients were screened at or near admission for acute rehabilitation, received calcium (1,000 mg daily) and calcitriol (0.25 lg daily) therapy daily, and on day 4, received a single dose of pamidronate, 90 mg by intravenous infusion, over 4 hours. Serum calcium and phosphate levels were closely monitored, and 2 weeks after pamidronate, biochemical bone markers were re-evaluated.Results: Responses of biochemical markers of bone resorption (N-telopeptide and 24-hour urinary calcium excretion) to pamidronate 90 mg were consistent with an antiresorptive effect, although less than that observed with a 30 mg/d 3 3-day pamidronate dosing regimen. The frequency of hypocalcemia was greater, and hypophosphatemia was less than the 30 mg/d 3 3-day pamidronate dosing regimen. Fever was more frequent (78%) with the 90-mg single dose of pamidronate compared with the 30 mg/d 3 3-day pamidronate dosing regimen (20%).Conclusions: Single-dose pamidronate 90 mg is effective at reducing biochemical markers of bone hyperresorption in patients with acute SCI but is associated with a greater incidence of fever compared with a 30 mg/d 3 3-day dosing regimen.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 80%

Section: Introductionmentioning

confidence: 97%

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Effect of a Convenient Single 90-mg Pamidronate Dose on Biochemical Markers of Bone Metabolism in Patients With Acute Spinal Cord Injury

Mechanick

Liu

Nierman

et al. 2006

The Journal of Spinal Cord Medicine

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“…7,12,13,23,32 Physical modalities (standing, FES cycle ergometry, 11-13 vibration 32,33 ) and pharmacological agents (amino-bisphosphonates [22][23][24] ) have been proposed as measures to slow the rapid loss of lower extremity bone after SCI. Although research data for patients with chronic SCI 12,13 suggest that FES could play an adjunctive role in the early clinical management of SCI bone loss, relatively few studies have evaluated the safety or efficacy of FES in the patient recently injured.…”

Section: Discussionmentioning

confidence: 99%

“…17,18,21 Preliminary data suggest that antiresorptive agents (aminobisphosphonates) may ameliorate SCI bone loss. [22][23][24] However, there are still many clinical uncertainties about the optimal time for the initiation of bone loss prevention protocols, and appropriate avenue(s) for early remediation.…”

Section: Introductionmentioning

confidence: 99%

Physiological effects of lower extremity functional electrical stimulation in early spinal cord injury: lack of efficacy to prevent bone loss

Clark

Jelbart

Rischbieth³

et al. 2006

Spinal Cord

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Study design: Controlled, repeat-measures study. Objectives: To determine if functional electrical stimulation (FES) can affect bone atrophy in early spinal cord injury (SCI), and the safety, tolerance and feasibility of this modality in bone loss remediation. Setting: Spinal Injuries Units, Royal Adelaide Hospital and Hampstead Rehabilitation Centre, South Australia. Methods: Patients with acute SCI (ASIA A-D) were allocated to FES (n ¼ 23, 2879 years, C4-T10, 13 Tetra) and control groups (CON, n ¼ 10, 31711 years, C5-T12, four Tetra). The intervention group received discontinuous FES to lower limb muscles (15 min sessions to each leg twice daily, over a 5-day week, for 5 months). Dual energy X-ray absorptiometry (DEXA) measured total body bone mineral density (tbBMD), hip, spine BMD and fat mass (FM) within 3 weeks, and 3 and 6 months postinjury. Results: FES and CON groups' tbBMD differed significantly at 3 months postinjury (Po0.01), but not thereafter. Other DEXA measures (hip, spine BMD, FM) did not differ between groups at any time. No adverse events were identified. Conclusion: Electrically stimulated muscle activation was elicited, and tetanic effects were reproducible; however, there were no convincing trends to suggest that FES can play a clinically relevant role in osteoporosis prevention (or subsequent fracture risk) in the recently injured patient. The lack of an osteogenic response in paralysed extremities to electrically evoked exercise during subacute and rehabilitation/recovery phases cannot be fully explained, and may warrant further evaluation.Spinal Cord (2007) 45, 78-85.

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„Critical illness“: erhöhtes Frakturrisiko und potenzielle Gegenmaßnahmen

Kerschan‐Schindl

2023

J. Miner. Stoffwechs. Muskuloskelet. Erkrank.

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ZusammenfassungBei kritisch kranken PatientInnen, die einer intensivmedizinischen Betreuung bedürfen, hat neben Inflammation, Medikation (zum Beispiel Glukokortikoide), Malnutrition und Vitamin-D-Mangel auch die Immobilisation besonders starke negative Auswirkungen auf Knochen- und Muskelstoffwechsel. Die Entkoppelung von Knochenresorption und -formation führt zu einem verstärkten Abbau von Knochenmasse und daher zu einer geringeren Belastbarkeit. Dies bedeutet bei erhöhtem Sturzrisiko ein gesteigertes Frakturrisiko, speziell bei der Remobilisation.Aus diesem Grund sollte trotz des akuten Geschehens nach der kardiorespiratorischen und neurologischen Stabilisierung der PatientInnen an die Frakturprävention gedacht werden. Eine Basismaßnahme ist die adäquate parenterale bzw. enterale Ernährung, wobei speziell auf ausreichende Zufuhr von Proteinen und Vitamin D zu achten ist. Wichtige Beiträge in der Protektion von Knochen und Muskel leisten ein gezieltes Training und eine frühzeitige Mobilisation. Auch wenn keine Osteoporosemedikamente für die Therapie bzw. Prävention der immobilisationsbedingten Osteoporose zugelassen sind, kann die Initiierung einer antiresorptiven Therapie mit Bisphosphonaten oder Denosumab im Sinne einer Einzelfallentscheidung während des Intensivaufenthaltes in Erwägung gezogen werden. Nach dem Aufenthalt auf der Intensivstation sollte das individuelle Frakturrisiko bestimmt und ggf. eine osteoporosespezifische Therapie eingeleitet werden. Die Fortsetzung der rehabilitativen Maßnahmen (progressives Training, Sturzprophylaxe) und die den jeweiligen Bedürfnissen entsprechende Supplementation von Vitamin D und Kalzium sind weitere wesentliche Bausteine in der Frakturprävention der Betroffenen nach ihrem Intensivaufenthalt.

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Combined Calcitriol-Pamidronate Therapy For Bone Hyperresorption In Spinal Cord Injury

Cited by 16 publications

References 0 publications

Effect of a Convenient Single 90-mg Pamidronate Dose on Biochemical Markers of Bone Metabolism in Patients With Acute Spinal Cord Injury

Effect of a Convenient Single 90-mg Pamidronate Dose on Biochemical Markers of Bone Metabolism in Patients With Acute Spinal Cord Injury

Physiological effects of lower extremity functional electrical stimulation in early spinal cord injury: lack of efficacy to prevent bone loss

„Critical illness“: erhöhtes Frakturrisiko und potenzielle Gegenmaßnahmen

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