Zoledronic acid improves bone mineral density in pediatric spinal cord injury

Abstract

Spinal cord injury (SCI) is associated with rapid and sustained bone loss and increase risk of fracture. Disuse is the primary cause for bone loss, although neural and hormonal changes may also contribute via different mechanisms. Bisphosphonates are used widely to treat osteoporosis in adults and are used increasingly for primary and secondary osteoporosis in children. Current data are insufficient to recommend routine use of bisphosphonates for fracture prevention in adult patients post-SCI and there are no available data in pediatric SCI. We report a 12-year-old boy with non-traumatic SCI who was treated with six monthly zoledronic acid (0.05 mg/kg/dose) for 18 months. The patient (AA) was diagnosed with transverse myelitis at 8.1 years of age, resulting in ventilator-dependent incomplete C3 tetraplegia. Following a fragility fracture to the surgical neck of the right humerus at 9.5 years of age, he was started on zoledronic acid. Bone turnover decreased and bone densitometry data (dual-energy X-ray absorptiometry [DXA] and peripheral quantitative computed tomography [pQCT]) showed improvement in metaphyseal and diaphyseal bone mineral content (BMC), volumetric bone mineral density (vBMD), and size, after 18 months of treatment. In the growing skeleton post-SCI, zoledronic acid potentially increases vertebral and long-bone strength by preserving trabecular bone (increased BMC and vBMD) and increasing cortical vBMD and cross-sectional area (CSA). ß

Bisphosphonate therapy in pediatric patients

“…The improvement of BMD with only one infusion of zoledronic acid every 6 months for 1 year, and 3 monthly infusion for 12 months, were similar in pediatric spinal cord injury [ 26 ]. Also, one single infusion of zoledronic acid in adult patients reduces >30% the rate of clinical fractures over 3 years of follow up, compared with placebo [ 27 ].…”

Bisphosphonate Treatment for Children With Disabling Conditions

“…The majority show a mild reduction in bone loss that is variably maintained, and results are insufficient to support routine use in patients without a history of fractures [84]. Data for bisphosphonate use in children with SCIs are limited to a single case report, in which a child treated with zoledronic acid for 18 months demonstrated significant gains in BMD [85]. Although use of bisphosphonates to prevent bone loss in adults with SCIs is not well supported, the potential for added benefits during bone modeling and skeletal growth justify additional investigation into the use of these medications in children.…”

Ossification and increased bone mineral density with zoledronic acid in a patient with lung adenocarcinoma: A case report

“…Ossification in the thoracic spine of one patient and in the rib of the other patient were observed (13). The BMD, as measured by DEXA, increases with the administration of ZA in post-menopausal osteoporosis patients (14), pediatric patients with spinal cord injury (15) and children with type III osteogenesis imperfecta (16). However, to the best of our knowledge, no study has revealed an improved BMD in the metastatic sites following the administration of ZA.…”