A single infusion of zoledronate prevents bone loss after stroke

Background and Purpose - Stroke is a major risk factor for hip fracture. Patients with intermediate rather than severe or mild stroke deficits at the time of hospital discharge have the most fractures. This proof-of-concept study evaluated the efficacy of a single infusion of zoledronate, an intravenous bisphosphonate, in preserving hip bone density after stroke. Methods - In a 1-year randomized, double-blind, placebo-controlled, clinical trial, 27 newly hemiplegic patients ( 6 females, 21 males) with acute stroke were assigned to receive 4 mg of the intravenous zoledronate ( n=14) or placebo ( n=13) within 35 days. Strict inclusion criteria were followed-up to ensure recruited patients were likely to have residual functional impairment. Both groups received calcium and vitamin D supplementation. The primary outcome measure was the change in bone mineral density ( BMD; Lunar Prodigy) at the hemiplegic hip during the year of investigation. Results - The treatment was generally well tolerated. Mean total hip BMD was unchanged in the hemiplegic hip of the zoledronate group ( mean 0.0% change), whereas in the placebo group the total hip BMD changed by -5.5%, with the greatest bone loss observed in the trochanteric subregion ( mean, -8.1%). On the unaffected side the mean change in total hip BMD was +1.0% with zoledronate versus a mean change of -2.7% without. Repeated measures ANOVA confirmed the significance of the differences between groups at both hips ( hemiplegic, P<0.001; unaffected, P=0.002). Conclusions - Stroke patients were protected from the deleterious effects of hemiplegia on hip bone density for at least 1 year after a single infusion of zoledronate.