Combined Interventions

As this chapter goes to press, the first generation of studies of combination interventions for the treatment of BMD decline in chronic SCI are being completed. These studies evaluate the concurrent administration of pharmacological therapy with non-pharmacological rehabilitation interventions. Some examples of registered trials include studies of zoledronate in combination with FES-rowing and recombinant PTH (Forteo) in combination with weight-bearing. Table 17 describes the early results from one such trial.


One study of concurrent teriparatide and body-weight supported treadmill stepping did not provide evidence in support of this combination intervention for the treatment of BMD decline in SCI. However, this study used a convenience sample with small sample size and was not powered to detect significant intervention effects. Three months of electroacupuncture and combination therapy seem to be sufficient to produce positive adaptations in BMD compared to individuals who received combination therapy only.


There is no evidence to support concurrent treatment of low bone mass with teriparatide and body-weight supported treadmill training (Gordon et al. 2013).