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Few studies have explored efficacy of antiresorptives for acute bone loss prevention post-TSCI, with limited data for knee bone mineral density (BMD) or beyond two years follow-up. An open-label non-randomized study was performed at Royal North Shore Hospital and Royal Rehab Centre, Sydney between 2018 and 2023. An \u2018acute interventional cohort\u2019 (<jats:italic>n<\/jats:italic>\u2009=\u200911) with TSCI (duration\u2009\u2264\u200912-weeks) received a single infusion of 4\u00a0mg zoledronic acid (ZOL) at baseline. A \u2018chronic non-interventional cohort\u2019 (<jats:italic>n<\/jats:italic>\u2009=\u20099) with TSCI (duration 1\u20135-years) did not receive ZOL. All participants underwent baseline and 6-monthly blood tests (including CTx and P1NP) and 12-monthly DXA BMD scans (including distal femur and proximal tibia). Participants were predominantly Caucasian and male (mean age 38.4\u00a0years). At baseline, the \u2018acute\u2019 cohort had higher serum CTx, P1NP and sclerostin concentrations, while the \u2018chronic\u2019 cohort had lower left hip and knee BMD. Majority with acute TSCI experienced an acute phase reaction after ZOL (9\/11; 82%). In the acute cohort, left hip BMD fell by mean\u2009~\u200915% by 48\u00a0months. Left distal femoral and proximal tibial BMD declined by mean\u2009~\u20096\u201313% at 12\u00a0months and\u2009~\u200920\u201323% at 48\u00a0months, with a tendency towards greater BMD loss in motor-complete TSCI. A single early ZOL infusion in acute TSCI could not attenuate rapidly declining hip and knee BMD. Prospective controlled studies are required to establish the optimal strategy for preventing early bone loss after acute TSCI.<\/jats:p>","DOI":"10.1007\/s00223-024-01292-3","type":"journal-article","created":{"date-parts":[[2024,9,25]],"date-time":"2024-09-25T06:05:29Z","timestamp":1727244329000},"page":"611-623","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Preventing OsteoPorosis in Spinal Cord Injury (POPSCI) Study\u2014Early Zoledronic Acid Infusion in Patients with Acute Spinal Cord Injury"],"prefix":"10.1007","volume":"115","author":[{"given":"Shejil","family":"Kumar","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean","family":"Doyle","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cameron","family":"Wood","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roxana","family":"Heriseanu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerard","family":"Weber","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lianne","family":"Nier","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James W.","family":"Middleton","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lyn","family":"March","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roderick J.","family":"Clifton-Bligh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8746-5529","authenticated-orcid":false,"given":"Christian M.","family":"Girgis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,9,25]]},"reference":[{"issue":"9","key":"1292_CR1","doi-asserted-by":"publisher","first-page":"812","DOI":"10.1038\/s41393-022-00795-w","volume":"60","author":"CB Amidei","year":"2022","unstructured":"Amidei CB, Salmaso L, Bellio S, Saia M (2022) Epidemiology of traumatic spinal cord injury: a large population-based study. 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Roderick J Clifton-Bligh has received honorarium from Amgen and Kyowa Kirin. Christian M Girgis has received honorarium from Kyowa Kirin, Gedeon Richter and Sandoz. Jean Doyle, Cameron Wood, Roxana Heriseanu, Gerard Weber, Lianne Nier, James W Middleton and Lyn March have no conflicts of interest to declare.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"All procedures performed in this study involving human participants were in accordance with the ethical standards of the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Ethics approval was obtained from the Northern Sydney Local Health District (NSLHD) Human Research Ethics Committee (2019\/ETH09718).","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Research Involving Human and Animal Participants"}},{"value":"Written informed consent was obtained from all individual participants included in this study.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed Consent"}}]}}