Bisphosphonate Use in Acute Spinal Cord Injury: A Focused Systematic Review on Zoledronic Acid
Abstract
Spinal cord injury (SCI) causes significant bone loss as a long-term complication, increasing fracture risk and healthcare costs. Bisphosphonates are widely studied for mitigating bone loss since they can prevent fractures and preserve rehabilitation potential in acute SCI patients. Zoledronic acid, in particular, stands out due to its high potency, dosing convenience, and better patient adherence. This review aims to evaluate the efficacy of bisphosphonates, particularly zoledronic acid, in mitigating bone loss in acute SCI. A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines using PubMed, ScienceDirect, PubMed Central (PMC), Google Scholar, and Cochrane Central Register of Controlled Trials (CENTRAL) databases. Studies from January 1, 2016, to December 31, 2024, on bisphosphonate use within six months of SCI were included. Randomized controlled trials using zoledronic acid as the intervention and meta-analyses or systematic reviews covering all bisphosphonates were selected based on predefined inclusion and exclusion criteria. Eight studies, comprising three meta-analyses and five randomized controlled trials with 729 participants, were selected after quality assessment using Assessment of Multiple Systematic Reviews 2 (AMSTAR 2) and a revised Cochrane risk of bias tool for randomized trials (RoB 2). Seven studies demonstrated significant bone mineral density (BMD) improvements at the…
How strong is the evidence?
Evidence Hub reads this as a systematic review, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 729 participants or records.
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