Background: The increased bone loss after spinal cord injury (SCI) is associated with an increase in
the morbidity and mortality of fragility fractures, which can constitute a substantial cost to health care systems.
Bisphosphonates (BPs) are now the principal class of medications used for osteoporosis.
Objective: To demonstrate the effect of BPs on treating osteoporosis after SCI.
Methods: A comprehensive search in PubMed, EMBASE, Web of Science and Cochrane Central databases was
undertaken for randomized controlled trials (RCTs), exploring the effect of BPs on osteoporosis after SCI. The
primary outcome measures were the BMD of different locations, serum bone turnover marker levels, serum biochemistry
marker levels and adverse effect (AE) risks. The final search was performed in September 2019. Reporting
was carried out according to PRISMA Guidelines.
Results: Six RCTs were included. A total of 147 patients met the inclusion criteria. BPs were found to statistically
prevent bone loss in the total hip, femoral neck and trochanter at the 6- and 12-month follow-up points and
to increase the BMD of the lumbar spine at the 12-month follow-up time point. BPs had no clear effect on serum
PINP or serum calcium levels at the 12-month follow-up time point.
Conclusion: BP therapy may prevent bone loss in the lumbar spine and hip when administered early after SCI
and has relatively high safety.