Osteoporosis prophylaxis in acute SCI

Spinal Cord Series and Cases, 2019 · DOI: https://doi.org/10.1038/s41394-019-0165-0 · Published: December 15, 2019

Spinal Cord Injury Rehabilitation Musculoskeletal Medicine

Simple Explanation

Osteoporosis is a significant complication following spinal cord injury (SCI), leading to increased fracture rates. However, the lack of robust clinical trials makes diagnosis and management challenging. Currently, there is limited evidence supporting the effectiveness of pharmacological or exercise-based treatments in preventing bone loss after SCI. Fracture incidence isn't a primary measure in existing clinical trials. The absence of standardized DXA scanning protocols for the distal femur and proximal tibia, common fracture sites post-SCI, further complicates bone density assessment and treatment strategies.

Study Duration

Not specified

Participants

Not specified

Evidence Level

Not specified

Key Findings

1
There's no definitive evidence that any intervention reduces fracture risk in acute or chronic SCI due to the absence of multi-center studies adequately assessing fracture rates.
2
Adverse events, specifically fractures, associated with weight-bearing therapies in individuals with low bone density and SCI might be underreported.
3
While drugs for osteoporosis are generally well-tolerated, the safety profile of denosumab is poorly studied in SCI, a condition associated with high rates of infection.

Research Summary

Osteoporosis is a serious complication after SCI, increasing fracture risk, but there is a lack of evidence-based guidelines for its prophylaxis and management. Current clinical practice varies widely due to the lack of rigorous clinical trials with fracture as a primary outcome, leading to uncertainty about the effectiveness of different interventions. The field would benefit from multi-center clinical trials powered for fracture as a primary outcome, and a consensus on bone density assessment protocols at the knee is needed.

Practical Implications

Need for Rigorous Trials

The absence of definitive clinical trials highlights the urgent need for well-powered, multi-center studies with fracture as the primary outcome to evaluate osteoporosis treatments in SCI.

Standardized Assessment Protocols

Consensus must be reached on standardized bone density assessment protocols, particularly at the knee, to improve diagnosis and monitoring of osteoporosis in SCI.

Careful Consideration of Therapies

Careful evaluation of the risk-benefit ratio of both pharmacological and exercise-based therapies is crucial, along with accurate reporting of adverse events, to ensure patient safety.

Study Limitations

1
Lack of rigorous, well-powered clinical trials with fracture as a primary outcome.
2
Absence of consensus on DXA scanning protocols at the distal femur or proximal tibia.
3
Potential underreporting of fracture events associated with weight-bearing therapies.

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