Evidence-based prevention and treatment of osteoporosis after spinal cord injury: a systematic review
Purpose Spinal cord injury (SCI) results in accelerated bone mineral density (BMD) loss and disorganization of trabecular bone architecture. The mechanisms underlying post-SCI osteoporosis are complex and different from other types of osteoporosis. Findings of studies investigating efficacy of pharm...
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| Veröffentlicht in: | European spine journal 2018-08, Vol.27 (8), p.1798-1814 |
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| creator | Soleyman-Jahi, Saeed Yousefian, Ali Maheronnaghsh, Radin Shokraneh, Farhad Zadegan, Shayan Abdollah Soltani, Akbar Hosseini, Seyed Mostafa Vaccaro, Alexander R. Rahimi-Movaghar, Vafa |
| description | Purpose
Spinal cord injury (SCI) results in accelerated bone mineral density (BMD) loss and disorganization of trabecular bone architecture. The mechanisms underlying post-SCI osteoporosis are complex and different from other types of osteoporosis. Findings of studies investigating efficacy of pharmacological or rehabilitative interventions in SCI-related osteoporosis are controversial. The aim of this study was to review the literature pertaining to prevention and evidence-based treatments of SCI-related osteoporosis.
Methods
In this systematic review, MEDLINE, EMBASE, PubMed, and the Cochrane Library were used to identify papers from 1946 to December 31, 2015. The search strategy involved the following keywords: spinal cord injury, osteoporosis, and bone loss.
Results
Finally, 56 studies were included according to the inclusion criteria. Only 16 randomized controlled trials (involving 368 patients) were found. We found following evidences for effectiveness of bisphosphonates in prevention of BMD loss in acute SCI: very low-quality evidence for clodronate and etidronate, low-quality evidence for alendronate, and moderate-quality evidence for zoledronic acid. Low-quality evidence showed no effectiveness for tiludronate. In chronic SCI cases, we found low-quality evidence for effectiveness of vitamin D
3
analogs combined with 1-alpha vitamin D
2
. However, low-quality inconsistent evidence exists for alendronate. For non-pharmacologic interventions, very low-quality evidence exists for effectiveness of standing with or without treadmill walking in acute SCI. Other low-quality evidences indicated that electrical stimulation, tilt-table standing, and ultrasound provide no significant effects. Very low-quality evidence did not show any benefit for low-intensity (3 days per week) cycling with functional electrical stimulator in chronic SCI.
Conclusions
No recommendations can be made from this review, regarding overall low quality of evidence as a result of high risk of bias, low sample size in most of the studies, and notable heterogeneity in type of intervention, outcome measurement, and duration of treatment. Therefore, future high-quality RCT studies with higher sample sizes and more homogeneity are strongly recommended to provide high-quality evidence and make applicable recommendations for prevention and treatment of SCI-related bone loss. |
| doi_str_mv | 10.1007/s00586-017-5114-7 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1899117027</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1899117027</sourcerecordid><originalsourceid>FETCH-LOGICAL-c372t-a074631c29332f08c1c4c26d831b86566a6bbb7f03b7e9e5ccd27035fd79eef03</originalsourceid><addsrcrecordid>eNp1kcGKFDEQhoMo7uzqA3iRgBcv0aqkO-l4k2V1hQUveg7pdLVkmO60SffKvP1mmFVB8BSofPUVVT9jrxDeIYB5XwDaTgtAI1rERpgnbIeNkgKskk_ZDmwDQhu0F-yylD0Athb0c3Yhu8Yaie2O0c19HGgOJHpfaOBLpnua15hm7ueBr5n8OtUCTyNPZaW0pJxKLNyPK2Veljj7Aw8pDzzO-y0fP3DPy7GSk19j4FUX6dcL9mz0h0IvH98r9v3TzbfrW3H39fOX6493IigjV-HBNFphkFYpOUIXMDRB6qFT2He61drrvu_NCKo3ZKkNYZAGVDsOxhLV8hV7e_YuOf3cqKxuiiXQ4eBnSltx2FmLaECair75B92nLddlipPQoUJQcBLimQp165JpdEuOk89Hh-BOGbhzBq5m4E4ZuJP59aN56yca_nT8PnoF5Bko9Wv-Qfnv6P9bHwBs-ZIl</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2081310300</pqid></control><display><type>article</type><title>Evidence-based prevention and treatment of osteoporosis after spinal cord injury: a systematic review</title><source>MEDLINE</source><source>Springer Nature - Complete Springer Journals</source><creator>Soleyman-Jahi, Saeed ; Yousefian, Ali ; Maheronnaghsh, Radin ; Shokraneh, Farhad ; Zadegan, Shayan Abdollah ; Soltani, Akbar ; Hosseini, Seyed Mostafa ; Vaccaro, Alexander R. ; Rahimi-Movaghar, Vafa</creator><creatorcontrib>Soleyman-Jahi, Saeed ; Yousefian, Ali ; Maheronnaghsh, Radin ; Shokraneh, Farhad ; Zadegan, Shayan Abdollah ; Soltani, Akbar ; Hosseini, Seyed Mostafa ; Vaccaro, Alexander R. ; Rahimi-Movaghar, Vafa</creatorcontrib><description>Purpose
Spinal cord injury (SCI) results in accelerated bone mineral density (BMD) loss and disorganization of trabecular bone architecture. The mechanisms underlying post-SCI osteoporosis are complex and different from other types of osteoporosis. Findings of studies investigating efficacy of pharmacological or rehabilitative interventions in SCI-related osteoporosis are controversial. The aim of this study was to review the literature pertaining to prevention and evidence-based treatments of SCI-related osteoporosis.
Methods
In this systematic review, MEDLINE, EMBASE, PubMed, and the Cochrane Library were used to identify papers from 1946 to December 31, 2015. The search strategy involved the following keywords: spinal cord injury, osteoporosis, and bone loss.
Results
Finally, 56 studies were included according to the inclusion criteria. Only 16 randomized controlled trials (involving 368 patients) were found. We found following evidences for effectiveness of bisphosphonates in prevention of BMD loss in acute SCI: very low-quality evidence for clodronate and etidronate, low-quality evidence for alendronate, and moderate-quality evidence for zoledronic acid. Low-quality evidence showed no effectiveness for tiludronate. In chronic SCI cases, we found low-quality evidence for effectiveness of vitamin D
3
analogs combined with 1-alpha vitamin D
2
. However, low-quality inconsistent evidence exists for alendronate. For non-pharmacologic interventions, very low-quality evidence exists for effectiveness of standing with or without treadmill walking in acute SCI. Other low-quality evidences indicated that electrical stimulation, tilt-table standing, and ultrasound provide no significant effects. Very low-quality evidence did not show any benefit for low-intensity (3 days per week) cycling with functional electrical stimulator in chronic SCI.
Conclusions
No recommendations can be made from this review, regarding overall low quality of evidence as a result of high risk of bias, low sample size in most of the studies, and notable heterogeneity in type of intervention, outcome measurement, and duration of treatment. Therefore, future high-quality RCT studies with higher sample sizes and more homogeneity are strongly recommended to provide high-quality evidence and make applicable recommendations for prevention and treatment of SCI-related bone loss.</description><identifier>ISSN: 0940-6719</identifier><identifier>EISSN: 1432-0932</identifier><identifier>DOI: 10.1007/s00586-017-5114-7</identifier><identifier>PMID: 28497215</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Alendronic acid ; Bisphosphonates ; Bone Density - drug effects ; Bone Density - physiology ; Bone Density Conservation Agents - therapeutic use ; Bone loss ; Bone mineral density ; Cancellous bone ; Clinical trials ; Clodronic acid ; Electric Stimulation - methods ; Electrical stimuli ; Etidronic acid ; Female ; Humans ; Male ; Medicine ; Medicine & Public Health ; Neurosurgery ; Osteoporosis ; Osteoporosis - etiology ; Osteoporosis - prevention & control ; Osteoporosis - therapy ; Prevention ; Quality ; Review ; Spinal cord injuries ; Spinal Cord Injuries - complications ; Surgical Orthopedics ; Systematic review ; Ultrasound ; Vitamin D - therapeutic use ; Vitamin D2 ; Vitamin D3 ; Zoledronic acid</subject><ispartof>European spine journal, 2018-08, Vol.27 (8), p.1798-1814</ispartof><rights>Springer-Verlag Berlin Heidelberg 2017</rights><rights>European Spine Journal is a copyright of Springer, (2017). All Rights Reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c372t-a074631c29332f08c1c4c26d831b86566a6bbb7f03b7e9e5ccd27035fd79eef03</citedby><cites>FETCH-LOGICAL-c372t-a074631c29332f08c1c4c26d831b86566a6bbb7f03b7e9e5ccd27035fd79eef03</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00586-017-5114-7$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00586-017-5114-7$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28497215$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Soleyman-Jahi, Saeed</creatorcontrib><creatorcontrib>Yousefian, Ali</creatorcontrib><creatorcontrib>Maheronnaghsh, Radin</creatorcontrib><creatorcontrib>Shokraneh, Farhad</creatorcontrib><creatorcontrib>Zadegan, Shayan Abdollah</creatorcontrib><creatorcontrib>Soltani, Akbar</creatorcontrib><creatorcontrib>Hosseini, Seyed Mostafa</creatorcontrib><creatorcontrib>Vaccaro, Alexander R.</creatorcontrib><creatorcontrib>Rahimi-Movaghar, Vafa</creatorcontrib><title>Evidence-based prevention and treatment of osteoporosis after spinal cord injury: a systematic review</title><title>European spine journal</title><addtitle>Eur Spine J</addtitle><addtitle>Eur Spine J</addtitle><description>Purpose
Spinal cord injury (SCI) results in accelerated bone mineral density (BMD) loss and disorganization of trabecular bone architecture. The mechanisms underlying post-SCI osteoporosis are complex and different from other types of osteoporosis. Findings of studies investigating efficacy of pharmacological or rehabilitative interventions in SCI-related osteoporosis are controversial. The aim of this study was to review the literature pertaining to prevention and evidence-based treatments of SCI-related osteoporosis.
Methods
In this systematic review, MEDLINE, EMBASE, PubMed, and the Cochrane Library were used to identify papers from 1946 to December 31, 2015. The search strategy involved the following keywords: spinal cord injury, osteoporosis, and bone loss.
Results
Finally, 56 studies were included according to the inclusion criteria. Only 16 randomized controlled trials (involving 368 patients) were found. We found following evidences for effectiveness of bisphosphonates in prevention of BMD loss in acute SCI: very low-quality evidence for clodronate and etidronate, low-quality evidence for alendronate, and moderate-quality evidence for zoledronic acid. Low-quality evidence showed no effectiveness for tiludronate. In chronic SCI cases, we found low-quality evidence for effectiveness of vitamin D
3
analogs combined with 1-alpha vitamin D
2
. However, low-quality inconsistent evidence exists for alendronate. For non-pharmacologic interventions, very low-quality evidence exists for effectiveness of standing with or without treadmill walking in acute SCI. Other low-quality evidences indicated that electrical stimulation, tilt-table standing, and ultrasound provide no significant effects. Very low-quality evidence did not show any benefit for low-intensity (3 days per week) cycling with functional electrical stimulator in chronic SCI.
Conclusions
No recommendations can be made from this review, regarding overall low quality of evidence as a result of high risk of bias, low sample size in most of the studies, and notable heterogeneity in type of intervention, outcome measurement, and duration of treatment. Therefore, future high-quality RCT studies with higher sample sizes and more homogeneity are strongly recommended to provide high-quality evidence and make applicable recommendations for prevention and treatment of SCI-related bone loss.</description><subject>Alendronic acid</subject><subject>Bisphosphonates</subject><subject>Bone Density - drug effects</subject><subject>Bone Density - physiology</subject><subject>Bone Density Conservation Agents - therapeutic use</subject><subject>Bone loss</subject><subject>Bone mineral density</subject><subject>Cancellous bone</subject><subject>Clinical trials</subject><subject>Clodronic acid</subject><subject>Electric Stimulation - methods</subject><subject>Electrical stimuli</subject><subject>Etidronic acid</subject><subject>Female</subject><subject>Humans</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Neurosurgery</subject><subject>Osteoporosis</subject><subject>Osteoporosis - etiology</subject><subject>Osteoporosis - prevention & control</subject><subject>Osteoporosis - therapy</subject><subject>Prevention</subject><subject>Quality</subject><subject>Review</subject><subject>Spinal cord injuries</subject><subject>Spinal Cord Injuries - complications</subject><subject>Surgical Orthopedics</subject><subject>Systematic review</subject><subject>Ultrasound</subject><subject>Vitamin D - therapeutic use</subject><subject>Vitamin D2</subject><subject>Vitamin D3</subject><subject>Zoledronic acid</subject><issn>0940-6719</issn><issn>1432-0932</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNp1kcGKFDEQhoMo7uzqA3iRgBcv0aqkO-l4k2V1hQUveg7pdLVkmO60SffKvP1mmFVB8BSofPUVVT9jrxDeIYB5XwDaTgtAI1rERpgnbIeNkgKskk_ZDmwDQhu0F-yylD0Athb0c3Yhu8Yaie2O0c19HGgOJHpfaOBLpnua15hm7ueBr5n8OtUCTyNPZaW0pJxKLNyPK2Veljj7Aw8pDzzO-y0fP3DPy7GSk19j4FUX6dcL9mz0h0IvH98r9v3TzbfrW3H39fOX6493IigjV-HBNFphkFYpOUIXMDRB6qFT2He61drrvu_NCKo3ZKkNYZAGVDsOxhLV8hV7e_YuOf3cqKxuiiXQ4eBnSltx2FmLaECair75B92nLddlipPQoUJQcBLimQp165JpdEuOk89Hh-BOGbhzBq5m4E4ZuJP59aN56yca_nT8PnoF5Bko9Wv-Qfnv6P9bHwBs-ZIl</recordid><startdate>20180801</startdate><enddate>20180801</enddate><creator>Soleyman-Jahi, Saeed</creator><creator>Yousefian, Ali</creator><creator>Maheronnaghsh, Radin</creator><creator>Shokraneh, Farhad</creator><creator>Zadegan, Shayan Abdollah</creator><creator>Soltani, Akbar</creator><creator>Hosseini, Seyed Mostafa</creator><creator>Vaccaro, Alexander R.</creator><creator>Rahimi-Movaghar, Vafa</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QP</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>20180801</creationdate><title>Evidence-based prevention and treatment of osteoporosis after spinal cord injury: a systematic review</title><author>Soleyman-Jahi, Saeed ; Yousefian, Ali ; Maheronnaghsh, Radin ; Shokraneh, Farhad ; Zadegan, Shayan Abdollah ; Soltani, Akbar ; Hosseini, Seyed Mostafa ; Vaccaro, Alexander R. ; Rahimi-Movaghar, Vafa</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c372t-a074631c29332f08c1c4c26d831b86566a6bbb7f03b7e9e5ccd27035fd79eef03</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Alendronic acid</topic><topic>Bisphosphonates</topic><topic>Bone Density - drug effects</topic><topic>Bone Density - physiology</topic><topic>Bone Density Conservation Agents - therapeutic use</topic><topic>Bone loss</topic><topic>Bone mineral density</topic><topic>Cancellous bone</topic><topic>Clinical trials</topic><topic>Clodronic acid</topic><topic>Electric Stimulation - methods</topic><topic>Electrical stimuli</topic><topic>Etidronic acid</topic><topic>Female</topic><topic>Humans</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Neurosurgery</topic><topic>Osteoporosis</topic><topic>Osteoporosis - etiology</topic><topic>Osteoporosis - prevention & control</topic><topic>Osteoporosis - therapy</topic><topic>Prevention</topic><topic>Quality</topic><topic>Review</topic><topic>Spinal cord injuries</topic><topic>Spinal Cord Injuries - complications</topic><topic>Surgical Orthopedics</topic><topic>Systematic review</topic><topic>Ultrasound</topic><topic>Vitamin D - therapeutic use</topic><topic>Vitamin D2</topic><topic>Vitamin D3</topic><topic>Zoledronic acid</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Soleyman-Jahi, Saeed</creatorcontrib><creatorcontrib>Yousefian, Ali</creatorcontrib><creatorcontrib>Maheronnaghsh, Radin</creatorcontrib><creatorcontrib>Shokraneh, Farhad</creatorcontrib><creatorcontrib>Zadegan, Shayan Abdollah</creatorcontrib><creatorcontrib>Soltani, Akbar</creatorcontrib><creatorcontrib>Hosseini, Seyed Mostafa</creatorcontrib><creatorcontrib>Vaccaro, Alexander R.</creatorcontrib><creatorcontrib>Rahimi-Movaghar, Vafa</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>European spine journal</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Soleyman-Jahi, Saeed</au><au>Yousefian, Ali</au><au>Maheronnaghsh, Radin</au><au>Shokraneh, Farhad</au><au>Zadegan, Shayan Abdollah</au><au>Soltani, Akbar</au><au>Hosseini, Seyed Mostafa</au><au>Vaccaro, Alexander R.</au><au>Rahimi-Movaghar, Vafa</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Evidence-based prevention and treatment of osteoporosis after spinal cord injury: a systematic review</atitle><jtitle>European spine journal</jtitle><stitle>Eur Spine J</stitle><addtitle>Eur Spine J</addtitle><date>2018-08-01</date><risdate>2018</risdate><volume>27</volume><issue>8</issue><spage>1798</spage><epage>1814</epage><pages>1798-1814</pages><issn>0940-6719</issn><eissn>1432-0932</eissn><abstract>Purpose
Spinal cord injury (SCI) results in accelerated bone mineral density (BMD) loss and disorganization of trabecular bone architecture. The mechanisms underlying post-SCI osteoporosis are complex and different from other types of osteoporosis. Findings of studies investigating efficacy of pharmacological or rehabilitative interventions in SCI-related osteoporosis are controversial. The aim of this study was to review the literature pertaining to prevention and evidence-based treatments of SCI-related osteoporosis.
Methods
In this systematic review, MEDLINE, EMBASE, PubMed, and the Cochrane Library were used to identify papers from 1946 to December 31, 2015. The search strategy involved the following keywords: spinal cord injury, osteoporosis, and bone loss.
Results
Finally, 56 studies were included according to the inclusion criteria. Only 16 randomized controlled trials (involving 368 patients) were found. We found following evidences for effectiveness of bisphosphonates in prevention of BMD loss in acute SCI: very low-quality evidence for clodronate and etidronate, low-quality evidence for alendronate, and moderate-quality evidence for zoledronic acid. Low-quality evidence showed no effectiveness for tiludronate. In chronic SCI cases, we found low-quality evidence for effectiveness of vitamin D
3
analogs combined with 1-alpha vitamin D
2
. However, low-quality inconsistent evidence exists for alendronate. For non-pharmacologic interventions, very low-quality evidence exists for effectiveness of standing with or without treadmill walking in acute SCI. Other low-quality evidences indicated that electrical stimulation, tilt-table standing, and ultrasound provide no significant effects. Very low-quality evidence did not show any benefit for low-intensity (3 days per week) cycling with functional electrical stimulator in chronic SCI.
Conclusions
No recommendations can be made from this review, regarding overall low quality of evidence as a result of high risk of bias, low sample size in most of the studies, and notable heterogeneity in type of intervention, outcome measurement, and duration of treatment. Therefore, future high-quality RCT studies with higher sample sizes and more homogeneity are strongly recommended to provide high-quality evidence and make applicable recommendations for prevention and treatment of SCI-related bone loss.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>28497215</pmid><doi>10.1007/s00586-017-5114-7</doi><tpages>17</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0940-6719 |
| ispartof | European spine journal, 2018-08, Vol.27 (8), p.1798-1814 |
| issn | 0940-6719 1432-0932 |
| language | eng |
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| source | MEDLINE; Springer Nature - Complete Springer Journals |
| subjects | Alendronic acid Bisphosphonates Bone Density - drug effects Bone Density - physiology Bone Density Conservation Agents - therapeutic use Bone loss Bone mineral density Cancellous bone Clinical trials Clodronic acid Electric Stimulation - methods Electrical stimuli Etidronic acid Female Humans Male Medicine Medicine & Public Health Neurosurgery Osteoporosis Osteoporosis - etiology Osteoporosis - prevention & control Osteoporosis - therapy Prevention Quality Review Spinal cord injuries Spinal Cord Injuries - complications Surgical Orthopedics Systematic review Ultrasound Vitamin D - therapeutic use Vitamin D2 Vitamin D3 Zoledronic acid |
| title | Evidence-based prevention and treatment of osteoporosis after spinal cord injury: a systematic review |
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