Summary

There is level 1 evidence (from 3 RCTs: Minaire et al. 1981, 1987; Chappard et al. 1995) that oral Tiludronate and Clodronate prevent a decrease in BMD of the hip and knee region with no adverse effects on bone mineralization in men with paraplegia.

There is level 1 evidence (from 1 RCT: Pearson et al. 1997) that oral Etidronate prevents a decrease in BMD of the hip and knee region in people with incomplete paraplegia or tetraplegia (AIS D impairment) who return to walking within 3 months of the SCI.

There is level 1 evidence (from 1 RCT: Gilchrist et al. 2007) that once weekly oral Alendronate maintains hip region BMD.

There is level 1 evidence (from 2 RCTs: Shapiro et al. 2007; Bubbear et al. 2011) that a one-time IV infusion of Zoledronate may reduce bone loss in the hip region during the 12 months following administration.

There is level 1 evidence (from 1 RCT: Bauman et al. 2005) that Pamidronate 60mg IV seven times per year and level 2 evidence (from 1 non-randomized prospective controlled trial) (Nance et al. 1999) that Pamidronate 30 mg IV six times per yearis not effective for the prevention of BMD loss at the hip and knee region early after SCI in men and women who have motor complete paraplegia or tetraplegia.

There is level 1 evidence (from 1 RCT: Zehnder et al. 2004) that Alendronate 10 mg daily and calcium 500mg orally 3x/day is effective for the maintenance of BMD of thetotal body, hip and knee region for men with paraplegia.

There is level 1 evidence (from 1 RCT: Bauman et al. 2005b) that vitamin D analog is effective for maintaining leg BMD.

There is level 1 evidence (from 1 RCT: Warden et al. 2001) that short-term (6 weeks) ultrasound is not effective for treating bone loss after SCI.

There is level 2 evidence (from 1 non-randomized prospective controlled trial: Shields et al. 2006a) that ES reduced the decline in BMD in the leg.

There is level 2 evidence (from 1 non-randomized prospective controlled trial: Eser et al. 2003) that FES cycling did not improve or maintain bone at the tibial midshaft in the acute phase.

There is level 4 evidence (from 1 pre-post study: Giangregorio et al. 2005) that walking and level 1 evidence (from 1 RCT: Ben et al. 2005) that standing in the acute phase did not differ from immobilization for bone mass decline at the tibia.

There is level 4 evidence (from 1 pre-post study: Astorino et al. 2013) that activity-based training 2-3 hours/day for a minimum of 2 days a week for 6 months increased spine BMD.

There is level 2 evidence (from 1 prospective controlled trial: Bélanger et al. 2000) that electrical stimulation either increased or maintained BMD over the stimulated areas.

There is level 4 evidence (from 1 pre-post study: Melchiorri et al. 2007) that vibration training did not improve or maintain BMC in the arms.

There is level 4 evidence (Mohr et al.1997; Chen et al. 2005; Frotzler et al. 2008) that FES cycle ergometry increased regional lower extremity BMD over areas stimulated.

There is inconclusive evidence for Reciprocating Gait Orthosis, long leg braces, passive standing or self-reported physical activity as a treatment for low bone mass.

There is level 4 evidence for quadriceps activation in stance with 150% body weight compressive load to increase BMD.

There is no evidence to support physical activity as a treatment for low bone mass after SCI.

There is no evidence to support concurrent treatment of low bone mass with teriparatide and body-weight supported treadmill training.

There is Level 4 evidence (Chen et al. 2001; Mechanick et al. 2006) to support the use of calcitriol-pamidronate therapy to reduce bone resorption in acute SCI.