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

Spinal Cord Series and Cases, 2019 · DOI: https://doi.org/10.1038/s41394-019-0166-z · Published: January 1, 2019

Spinal Cord Injury Pharmacology Musculoskeletal Medicine

Simple Explanation

In individuals with SCI, osteoporosis and fragility fractures are common, leading to significant health issues. Preventing osteoporosis is crucial, but current research lacks clear guidance on interventions to identify and protect those at highest risk. Without proper research, doctors cannot accurately assess if the benefits of strong medications like bisphosphonates outweigh the risks. Some treatments, like physical activity, pose less risk and offer other health advantages. This article argues that current research does not support using preventative drug treatments to combat osteoporosis in people with SCI, highlighting the need for more targeted research.

Study Duration

Not specified

Participants

Not specified

Evidence Level

Perspective

Key Findings

1
Bisphosphonate therapy after acute SCI may attenuate bone mineral density (BMD) loss in comparison to no treatment if administered acutely after injury.
2
Mechanical loading is the most profound stimulus for bone remodeling, and many studies have investigated various methods and frequencies of interventions to increase or reduce loss of BMD.
3
SCI clinicians currently lack the guidance on length of pharmacological therapy necessary to weigh the risks and beneﬁts of medication administration.

Research Summary

Osteoporosis and fragility fractures are prevalent and clinically meaningful in the SCI population. Prevention is a critical area of research. Although many osteoporosis medications demonstrate variable degrees of ameliorating BMD loss, SCI clinicians currently lack the guidance on length of pharmacological therapy necessary to weigh the risks and beneﬁts of medication administration. Because of these reasons, we argue that the current research does not indicate for prophylactic treatment to prevent osteoporosis in the SCI population.

Practical Implications

Further Research Needed

More research is needed to determine effective and safe prophylactic interventions for osteoporosis in the SCI population.

Cautious Use of Bisphosphonates

Clinicians should exercise caution when considering bisphosphonates for prophylactic osteoporosis treatment in SCI due to potential risks and lack of clear guidelines.

Encourage Physical Modalities

Physical modalities should be encouraged due to their added benefits related to cardiovascular health and relatively low risk of side effects.

Study Limitations

1
Lack of clear guidance on prophylactic interventions.
2
Variability in intervention frequency and intensity have demonstrated inconclusive results.
3
Current research cannot conclude on a specific mechanical loading program that is feasible in the clinical setting.

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