Effect of early treatment with zoledronic acid on prevention of bone loss in patients with acute spinal cord injury: a randomized controlled trial.

STUDY DESIGN: Randomized controlled trial. OBJECTIVES: To determine the effect of zoledronic acid on bone loss in people with acute spinal cord injury (SCI) SETTINGS: Sawai Man Singh Medical College, India. METHODS: Sixty patients with acute SCI were randomized to receive either standard treatment alone or standard treatment with zoledronic acid within 3 months after injury. Areal bone mineral density (aBMD) was measured at the hip using dual-energy X-ray absorptiometry (DXA) at baseline 3, 6, and 12 months. RESULTS: Significant differences in aBMD were found between the standard treatment alone and standard treatment plus zoledronic acid group at the femoral neck (-0.13; 95% CI, -0.18 to -0.09, p < 0.0001), and total hip (-0.16; 95% CI, -0.19 to -0.12, p < 0.0001), respectively, at 1 year and bone loss was reduced in the zoledronic acid treated group as compared to the standard treatment group. Significant differences in aBMD between the groups at 6 months post infusion was also observed at these sites. [Femoral neck -0.08; 95% CI, -0.12 to -0.03; p = 0.002 and total hip -0.12; 95% CI, -0.15 to -0.08; p < 0.0001] CONCLUSION: A zoledronic acid 5 mg infusion given within 3 month significantly reduces bone loss at the hip after 6 months post infusion in patients with acute SCI.

Zoledronic Acid Attenuates Early Bone Loss at Forearm in Patients with Acute Spinal Cord Injury.

STUDY DESIGN: Randomized controlled trial. OBJECTIVES: To study the magnitude of bone loss at forearm in persons with acute spinal cord injury (SCI) & the effect of early administration of Zoledronic acid on its' prevention. SETTINGS: Sawai Man Singh Medical College, Jaipur, India. METHODS: Sixty patients with acute SCI were randomized either to receive standard medical and nursing care or Zoledronic acid infusion in combination with standard medical and nursing care. Areal bone mineral density (aBMD) was measured at the forearm (radius + ulna) once patients were medically stable using Dual Energy X-Ray Absorptiometry (DXA) at baseline and at 3, 6 and 12 months. RESULTS: Significant differences in aBMD was found between the control & Zoledronic acid group at 1/3 forearm (- 0.064; 95% CI - 0.092 to - 0.036, p = 0.001), mid forearm (- 0.059; 95% CI - 0.084 to - 0.034, p = 0.001), UD forearm (- 0.048; 95% CI - 0.097 to 0.001, p = 0.016) and total forearm (- 0.048; 95% CI - 0.088 to - 0.008, p = 0.021) at 1 year in the paraplegic patients with SCI. Similar significant difference was also observed at 1/3 forearm (- 0.046; 95% CI - 0.073 to - 0.019, p = 0.002), mid forearm (- 0.063; 95% CI - 0.088 to - 0.037, p < 0.0001), UD forearm (- 0.084; 95% CI - 0.101 to - 0.067, p < 0.0001) and total forearm (- 0.115; 95% CI - 0.132 to - 0.097, p < 0.0001) respectively at 1 year in the quadriplegic patients with SCI. Significant differences in aBMD between the groups at 6 months post infusion was also observed at these sites in quadriplegic patients. [1/3 forearm - 0.022; 95% CI - 0.039 to - 0.005; p = 0.015, Mid forearm - 0.023; 95% CI - 0.042 to - 0.004; p = 0.019, UD forearm - 0.041; 95% CI - 0.055 to - 0.027; p < 0.0001 and Total forearm - 0.049; 95%CI - 0.062 to - 0.036; p < 0.0001]. Bone loss was reduced in the Zoledronic acid treated group compared to the standard treatment group in both paraplegic and quadriplegic patients. CONCLUSION: Single dose of 5mg intravenous Zoledronic acid is an effective treatment in preventing bone loss at the forearm for 12 months following acute spinal cord injury.

Effect of serial casting in spastic cerebral palsy.

OBJECTIVE: Cerebral palsy (CP) is a range of non progressive syndromes of posture and motor impairment due to an insult to developing brain. Spasticity and incoordination are major causes of disability in these children which can be managed by different modalities like casting, botulinum toxin, surgery etc. Cast application in spastic equinus is a well established procedure in CP but cast application in patients of CP with bilateral involvement of hip, knee and ankle is not document. METHODS: A study was conducted on 22 children of spastic CP in age range of 3-8 years with bilateral involvement of hip, knee and ankle in 20 cases, hip and ankle in one case and only ankle in one case. Sixty eight % children were spastic diplegics. Serial weekly cast with (11 cases) or without abductor bar (11 cases) was applied for four weeks. They were followed up variably with an average period of 7 months. RESULTS: Significant improvement was noticed in range of motion around hip, knee and ankle which as maintained over hip and knee after average follow up. Spasticity was also reduced as measured by Modified Ashworth Scale (MAS). This ultimately improved the ambulatory status and functional ability of these children. CONCLUSION: Thus serial casting is a very simple, safe and cost effective procedure which can be applied even in children with mental sub normality having all three major joints involved bilaterally.