Cyclical etidronate: its effect on bone density in patients with acute spinal cord injury.

OBJECTIVE

To compare the effects of a 30-week trial of cyclical etidronate therapy (starting within 6 weeks of spinal cord injury [SCI] and conventional rehabilitation without etidronate treatment on the bone density of the lumbar spine and lower extremities of SCI patients.

DESIGN

Prospective, randomized control trial.

SETTING

Tertiary care, inpatient rehabilitation center.

PATIENTS: Acute SCI, within 6 weeks of injury. Thirteen SCI subjects were recruited; 6 were assigned randomly to receive etidronate and 7 to receive conventional treatment.

INTERVENTION: Etidronate, 800 mg orally, once per day for 2 weeks of 15 weeks, repeated once.

MAIN OUTCOME MEASURES: Dual X-ray absorptiometry of the spine, hip, distal femur, and proximal tibia measured at baseline, 6 months, and 12 months.

RESULTS

A significant interaction between etidronate treatment and ambulatory status over time was observed in the bone density of the patients after SCI (p = .0003). The patients who became ambulatory and received etidronate treatment had a preservation of bone density as compared to all other patients who showed a loss of bone density over time. The loss of bone density occurred in the leg bones, not the spine. Cyclical etidronate treatment was tolerated well without adverse or side effects.

CONCLUSION

Cyclical etidronate is a feasible treatment and may prevent osteoporosis associated with SCI in patients who eventually walk.