Correspondence: "Effect of early treatment with zoledronic acid on prevention of bone loss in patients with acute spinal cord injury: a randomized controlled trial".
Correspondence: "Effect of early treatment with zoledronic acid on prevention of bone loss in patients with acute spinal cord injury: a randomized controlled trial".
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通讯：“唑来膦酸早期治疗对预防急性脊髓损伤患者骨质流失的效果：一项随机对照试验”。
DOI：
10.1038/s41393-018-0221-9
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发表时间：
2018
期刊：
影响因子：
2.2
通讯作者：
Beaupre,GaryS
中科院分区：
文献类型：
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作者：
Beaupre,GaryS
我怀着极大的兴趣阅读了Goenka等人最近的文章。[1]使用唑来膦酸（ZA）治疗脊髓损伤（SCI）患者的急性骨丢失。作者对文学的重要贡献值得祝贺。他们的随机对照试验（RCT）包括60名被分为两组的受试者，比以前关于同一主题的研究大三到四倍[2-4]。这样一个大型随机对照试验在统计学功效上的相关改善代表了该研究领域的实质性益处。作者的研究值得评论的一个方面是他们选择骨密度测量的骨骼部位。在他们的引言中，作者正确地指出SCI后的脆性骨折最常发生在股骨远端和胫骨近端。鉴于这种认识，不幸的是，作者选择将他们的骨密度测量限制在髋关节。Bauman等人[3]和Schnitzer et al. [4]先前在脊髓损伤患者ZA治疗的研究中检查了股骨远端和胫骨近端的骨变化。这两项脊髓损伤后ZA治疗的研究是迄今为止唯一报道膝关节附近骨密度的研究。这两项研究令人困惑的是，它们显示出相互矛盾的趋势。Schnitzer等人的结果表明，ZA治疗股骨远端具有获益，尽管该效应不具有统计学显著性。Bauman等人的结果表明ZA对膝关节BMD有负面影响。如果Bauman等人的反直觉的结果被重复，这将引起一个关于使用ZA治疗SCI后骨丢失的严重问题。它
It was with great interest that I read the recent article by Goenka et al.[1] on the use of zoledronic acid (ZA) to treat acute bone loss in patients with spinal cord injury (SCI). The authors are to be congratulated for their important contribution to the literature. Their randomized controlled trial (RCT), which included 60 subjects divided into two groups, is three to four times larger than previous studies on the same topic [2–4]. The associated improvement in statistical power with such a large RCT represents a substantial benefit to the research field.One aspect of the authors' study that deserves comment is their choice of skeletal sites for bone density measurements. In their Introduction, the authors correctly note that fragility fractures post SCI most commonly occur in the distal femur and proximal tibia. Given that recognition, it is unfortunate that the authors chose to limit their bone density measurements to the hip. Bauman et al.[3] and Schnitzer et al.[4] have previously examined bone changes in the distal femur and proximal tibia in studies of ZA treatment in patients with SCI. Those two studies of ZA treatment post SCI are the only ones to date that have reported bone density near the knee. What is perplexing about those two studies is they show contradictory trends. The results of Schnitzer et al. suggest a benefit of ZA treatment in the distal femur, although the effect was not statistically significant. The results of Bauman et al. suggest a negative effect of ZA on knee BMD. If the counterintuitive results of Bauman et al. are replicated, it would raise a serious question about the use of ZA tor treating post-SCI bone loss. It