Abstract(Please copy/paste the abstract send to the congress) : |
Evidence-based prevention and treatment of osteoporosis after spinal cord injury: A Systematic Review
Authors:
Ali Yousefian1
Radin Maheronnaghsh1
Saeed Soleyman-Jahi2
Farhad Shokraneh3
Akbar Soltani4
Seyed Mostafa Hosseini5
Alexander R Vaccaro6
Vafa Rahimi-Movaghar*1,7
1Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
2Medical School, Tehran University of Medical Sciences, Tehran, Iran
3Cochrane Schizophrenia Group, the Institute of Mental Health, a partnership between the University of Nottingham and Nottinghamshire Healthcare NHS Trust, Nottingham, United Kingdom
4Endocrinology & Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
5Department of Epidemiology and Biostatistics, School of Public Health and Institute of Public Health Research, Tehran University of Medical Sciences , Tehran, Iran
6Department of Orthopedics and Neurosurgery, Thomas Jefferson University and the Rothman Institute, Philadelphia, PA, USA
7Research Centre for Neural Repair, University of Tehran, Tehran, Iran
*Corresponding author:
Vafa Rahimi-Movaghar, MD,
Professor of Neurosurgery
1- Sina Trauma and Surgery Research Center,
Tehran University of Medical Sciences, Tehran, Iran
2- Research Centre for Neural Repair,
University of Tehran, Tehran, Iran
Address:
Sina Trauma and Surgery Research Center,
Sina Hospital, Hassan-Abad Square, Imam Khomeini Ave,
Tehran University of Medical Sciences,
Tehran, 11365-3876, Iran
Phone: (+98) 915 342 2682, (+98) 216 675 7001
Fax: (+98) 216 675 7009
Email: v_rahimi@sina.tums.ac.ir
Email: v_rahimi@yahoo.com
Funding: The study was supported by AOSME (AOSpine of Middle East) and Sina Trauma and Research Center of Tehran University of Medical Sciences.
Competing interest: None.
Contributors: All authors contributed in data gathering and writing and editing the draft of the manuscript. All authors read and approved the final version of manuscript.
Short running title: Osteoporosis after spinal cord injury
Key points
1. Many studies were small and of poor quality, and none included fracture outcomes. Therefore, available data is insufficient to endorse the routine use of any of the proposed interventions for fracture prevention in patients with SCI.
2. There was low to moderate quality evidence that use of Bisphosphonates is effective in the prevention or treatment of bone loss in the first year after injury. The evidence for Clodronate is moderate-quality and for Etidronate, Alendronate, Zoledronic acid is low-quality.
3. There was low-quality evidence that use of Vitamin-D analogous and Alendronate plus calcium is effective in the prevention or treatment of bone loss for one year and beyond.
4. There was low-quality evidence that electrical stimulation is useful in preventing bone loss after acute SCI.
5. For other rehabilitation modalities after SCI evidence is lacking to draw any conclusions in preventing bone loss.
Mini-abstract
Our systematic review showed that there was low to moderate quality evidence for Bisphosphonates efficacy in the prevention/treatment of bone loss in the first year after spinal cord injury (SCI) and low-quality evidence for Vitamin-D analogous and Alendronate plus calcium for ≥one year and for electrical stimulation in acute SCI.
Abstract
Study Design: Systematic review
Summary of Background Data: Spinal cord injury (SCI) leads to a profound reduction in bone mineral density (BMD) and disturbances of the skeletal trabecular microarchitecture. The pathogenesis of osteoporosis after SCI is complex and differs from other forms of this problem.
Objective: The aim of this study is to review the most recent literature on evidence-based prevention and treatments of osteoporosis in SCI patients.
Methods: The Cochrane Library, EMBASE (excluding MEDLINE) (1974 – 2015 Week 24), MEDLINE (1946 – June 17, 2015), and PubMed (excluding MEDLINE) (1946 – June 17, 2015) were comprehensively searched. The search strategy involved the following keywords: spinal cord injury, osteoporosis, bone loss, evidence, screening, and treatment.
Results: A total of 51 studies met inclusion criteria. Fifteen out of 51 were randomized controlled trials involving 356 patients. Many studies were small and of poor quality, and none included fracture outcomes. There was low to moderate quality evidence that use of Bisphosphonates is effective in the prevention or treatment of bone loss in the first year after injury. The evidence for Clodronate is moderate-quality and for Etidronate, Alendronate, Zoledronic acid is low-quality. There was low-quality evidence that use of Vitamin-D analogous and Alendronate plus calcium is effective in the prevention or treatment of bone loss for one year and beyond. There was low-quality evidence that electrical stimulation is useful in preventing bone loss after acute SCI. For other rehabilitation modalities after SCI evidence is lacking to draw any conclusions in preventing bone loss.
Conclusions: Available data is insufficient to endorse the routine use of any of the proposed interventions for fracture prevention in patients with SCI.
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