Prophylactic treatment of osteoporosis after SCI: promising research, but not yet indicated

Abstract

In persons with spinal cord injury (SCI), osteoporosis and associated fragility fractures are a prevalent phenomenon with clinically meaningful morbidity and mortality. Prevention of osteoporosis utilizing both physical modalities and pharmacological therapies is an area of high-clinical importance. In our perspective, the current body of research cannot provide clear guidance on prophylactic interventions to prevent osteoporosis specifically to stratify SCI subjects to their risk for fragility fractures. Without this critical research, clinicians cannot weigh the risk versus benefits of interventions, such as bisphosphonates, which is not a benign treatment. Other treatments such as physical modalities provide little risk and have other therapeutic benefit. This perspective is an argument that the current research does not indicate prophylactic pharmacological intervention to prevent osteoporosis in the SCI population.

Comparison of Bone Loss and Associated Risk Factors in Men with Spinal Cord Injury and Community-dwelling Adults

“…Based on current evidence, various bisphosphonates, including oral etidronate and intravenous zoledronate, have shown e cacy in slowing BMD decline in the hip and knee region [28][29][30][31] . Nevertheless, no de nite pharmacologic guidelines for reducing the actual fracture risk in SCI have been set 32,33 , and further research should propose enhanced evidence-based preventative measures in which the fracture itself is an endpoint.…”

Characteristics Associated with Bone Loss after Spinal Cord Injury: Implications for Hip Region Vulnerability

“…Based on current evidence, various bisphosphonates, including oral etidronate and intravenous zoledronate, have shown efficacy in slowing the decline in BMD of the hip and knee regions [28][29][30][31]. Nevertheless, there are currently no definite pharmacologic guidelines to reduce the actual fracture risk in SCI [32,33]. Future research should propose evidencebased preventative measures with the fracture itself as an endpoint.…”

Parasport: Effects on Musculoskeletal Function and Injury Patterns

“…All para athletes with SCI should be tested for vitamin-D deficiency, as deficiency is ubiquitous in this population [65][66][67] , and be provided with supplements accordingly. Bisphosphonates, in conjunction with endocrinology consultation, can also be considered for athletes with SCI who have osteoporosis; however, bisphosphonates should be used with caution in athletes of childbearing age, given possible adverse effects on pregnancy [68][69][70][71] . Furthermore, emerging techniques that may stimulate osteogenesis without weight-bearing, such as functional electrical stimulation [72][73][74] , can also be considered for those athletes at risk for pathologic fractures.…”