As biomarker science improves, the utility of urinary and serum biomarkers of bone turnover continues to increase. While BMD is considered the gold standard outcome measure for bone health interventions, this outcome is not always available. In particular, retrospective studies may not have access to BMD data, and may therefore report only biomarker outcomes. Table 14 describes several such studies.
Table 14: Studies of Bone Health Interventions with Biomarker Outcome
Discussion
Two retrospective case series studies (Chen et al. 2001; Mechanick et al. 2006) provide Level 4 evidence supporting the use of calcitriol-pamidronate therapy to reduce urinary excretion of calcium and NTx in acute SCI, which are biomarkers of bone resorption. Single-dose infusion of pamidronate was associated with increased incidence of fever compared to infusion on three consecutive days. However, single-dose pamidronate may be a more efficient use of patients’ time during ever-shorter inpatient rehabilitation stays.
One study (Bauman et al. 2009) provided Level 4 evidence that calcium gluconate infusion may reduce transient bone collagen catabolism in men with chronic SCI.
Conclusion
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.
