The role of Bisphosphonates in the prevention and treatment of Heterotopic Ossification following Spinal Cord Injury: A systematic review.

Abstract

Heterotopic ossification (HO) is a frequent complication following spinal cord injury (SCI), yet evidence regarding the efficacy of bisphosphonates in managing this condition remains limited. This systematic review aims to evaluate the role of bisphosphonates in the prevention and treatment of HO in patients with SCI. A comprehensive search of PubMed, CINAHL, ScienceDirect, Cochrane Library, and the Centre for Reviews and Dissemination databases was conducted to identify studies meeting predefined inclusion criteria. Relevant articles were also identified through bibliographic references. A total of 11 studies were included: nine investigating etidronate, one on alendronate, and one on pamidronate. Bisphosphonate administration varied, with oral etidronate provided for a minimum of 12 weeks and intravenous pamidronate given for up to 14 days. Bisphosphonates were used either prophylactically or therapeutically to delay the progression of HO. Findings across all studies highlighted the preventive role of bisphosphonates in reducing the occurrence of HO in SCI patients and demonstrated their therapeutic potential, as evidenced by less extensive heterotopic bone formation. However, the available evidence remains insufficient to draw definitive conclusions about the optimal use of bisphosphonates in this population. Further well-designed clinical trials are required to elucidate their preventive and therapeutic efficacy in managing HO after SCI.