Zoledronic acid improves bone mineral density in pediatric spinal cord injury
Zoledronic acid improves bone mineral density in pediatric spinal cord injury
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DOI：
10.1002/jbmr.1598
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发表时间：
2012-07-01
影响因子：
6.2
通讯作者：
Munns, Craig F.
中科院分区：
文献类型：
--
作者：
Ooi, Hooi Leng;Briody, Julie;Munns, Craig F.
脊髓损伤（SCI）与快速和持续的骨质流失有关，并增加骨折的风险。废用是骨质流失的主要原因，尽管神经和激素的变化也可能通过不同的机制起作用。双膦酸盐广泛用于治疗成人骨质疏松症，并且越来越多地用于治疗儿童原发性和继发性骨质疏松症。目前的数据不足以推荐常规使用双磷酸盐预防 SCI 后成人患者骨折，并且没有儿童 SCI 的可用数据。我们报告了一名患有非创伤性 SCI 的 12 岁男孩，他接受了 6 个月一次的唑来膦酸（0.05mg/kg/剂量）治疗，为期 18 个月。患者（AA）在8.1岁时被诊断出患有横贯性脊髓炎，导致呼吸机依赖的不完全C3四肢瘫痪。 9.5 岁时，右肱骨手术颈发生脆性骨折，随后他开始服用唑来膦酸。治疗 18 个月后，骨转换减少，骨密度测定数据（双能 X 射线吸收测定法 [DXA] 和外周定量计算机断层扫描 [pQCT]）显示干骺端和骨干骨矿物质含量 (BMC)、体积骨矿物质密度 (vBMD) 和大小有所改善。在 SCI 后生长的骨骼中，唑来膦酸可通过保留骨小梁（增加 BMC 和 vBMD）以及增加皮质 vBMD 和横截面积（CSA）来潜在地增加椎骨和长骨强度。 (c) 2012 年美国骨与矿物质研究学会。
Spinal cord injury (SCI) is associated with rapid and sustained bone loss and increase risk of fracture. Disuse is the primary cause for bone loss, although neural and hormonal changes may also contribute via different mechanisms. Bisphosphonates are used widely to treat osteoporosis in adults and are used increasingly for primary and secondary osteoporosis in children. Current data are insufficient to recommend routine use of bisphosphonates for fracture prevention in adult patients post-SCI and there are no available data in pediatric SCI. We report a 12-year-old boy with non-traumatic SCI who was treated with six monthly zoledronic acid (0.05?mg/kg/dose) for 18 months. The patient (AA) was diagnosed with transverse myelitis at 8.1 years of age, resulting in ventilator-dependent incomplete C3 tetraplegia. Following a fragility fracture to the surgical neck of the right humerus at 9.5 years of age, he was started on zoledronic acid. Bone turnover decreased and bone densitometry data (dual-energy X-ray absorptiometry [DXA] and peripheral quantitative computed tomography [pQCT]) showed improvement in metaphyseal and diaphyseal bone mineral content (BMC), volumetric bone mineral density (vBMD), and size, after 18 months of treatment. In the growing skeleton post-SCI, zoledronic acid potentially increases vertebral and long-bone strength by preserving trabecular bone (increased BMC and vBMD) and increasing cortical vBMD and cross-sectional area (CSA). (c) 2012 American Society for Bone and Mineral Research.