This was a double-blind, randomized, placebo-controlled parallel-group pilot trial to observe the effect of single-dose zoledronic acid on bone mineral density (BMD) in persons with chronic spinal cord injury (SCI). Twenty-eight subjects with traumatic SCI, at least 1 year after trauma who had osteoporosis were randomized to receive either intervention or placebo. The intervention consisted of a single dose of intravenous zoledronic acid (Zoldonat) 4 mg in 100 ml of normal saline infused over 20 minutes. The placebo group received 100 ml of normal saline infusion. BMD of hip and forearm was measured by dual-energy x-ray absorptiometry (DEXA) at baseline and 1 year after intervention. A nonparametric test, the Wilcoxon signed-rank test, was used to evaluate the postintervention change in BMD. BMD of distal forearm showed a statistically significant rise in both groups after intervention (p = 0.004 in placebo group, p = 0.004 in zoledronic acid group). At 1 year, BMD of total hip in the placebo group showed a statistically significant reduction (p = 0.017), whereas that the zoledronic acid group did not show a statistically significant reduction (p = 0.082). BMD of femoral neck showed a statistically significant reduction in both groups (p = 0.002 in the placebo group; p = 0.044 in the zoledronic acid group). However, the magnitude of decrease was greater in placebo recipients. We conclude that a single dose of zoledronic acid partially prevents ongoing reduction in BMD at total hip but not at femoral neck in patients with chronic SCI.
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