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 · DOI: 10.1371/journal.pone.0081124 · Published: November 22, 2013

Spinal Cord Injury Rehabilitation Musculoskeletal Medicine

Simple Explanation

Spinal cord injuries (SCI) often lead to bone mineral density (BMD) loss below the injury site. This bone loss increases the risk of fractures and other complications. This study investigates two common interventions: bisphosphonate analogues (medications) and functional electrical stimulation (FES) to see if they can prevent or reverse this bone loss. The study analyzed data from 19 previous studies involving 364 SCI patients and 14 healthy individuals. The analysis looked at how BMD changed over time (up to 18 months) after either bisphosphonate treatment or FES training. The findings suggest that bisphosphonates can help reduce bone loss in the early stages after SCI, while FES training can increase BMD in chronic SCI patients, especially near the areas where muscles are being used and loaded mechanically.

Study Duration

Not specified

Participants

364 patients and 14 healthy individuals

Evidence Level

Systematic Review and Meta-Analysis

Key Findings

1
Acute SCI patients treated with bisphosphonates showed a trend toward less bone loss compared to those receiving a placebo or usual care, with significant differences noted at 3 and 12 months post-medication.
2
In chronic SCI patients, FES training resulted in significant BMD increases of 5.96%, 7.21%, and 9.56% at 3, 6, and 12 months post-treatment, respectively.
3
FES training regimens of ≥5 days per week were found to be more effective than those of ≤3 days per week in chronic SCI patients.

Research Summary

This meta-analysis examined the effectiveness of bisphosphonates and FES in preventing bone loss following SCI. It included 19 studies with a total of 364 SCI patients and 14 healthy controls. The results indicated that bisphosphonate administration early after SCI can attenuate sublesional bone loss. FES intervention in chronic SCI patients can significantly increase sublesional BMD near the sites of maximal mechanical loading. The study also found that a higher frequency of FES training (≥5 days per week) was associated with greater improvements in BMD compared to lower frequency training.

Practical Implications

Early Bisphosphonate Intervention

Administer bisphosphonates early after SCI to minimize initial bone loss.

Consistent FES Training

Implement FES training programs for chronic SCI patients to enhance BMD, focusing on areas with mechanical loading.

High-Frequency FES Regimens

Structure FES training at a frequency of at least 5 days per week to maximize effectiveness.

Study Limitations

1
Lack of long-term follow-up data on fracture incidence.
2
Most FES studies had pre-post test designs without random assignment or comparison groups.
3
Diversity of bisphosphonate dosages and administration protocols across studies.

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