Effect of bisphosphonates or teriparatide on mechanical complications after posterior instrumented fusion for osteoporotic vertebral fracture: a multi-center retrospective study

Kawabata, Atsuyuki; Yoshii, Toshitaka; Hirai, Takashi; Ushio, Shuta; Kaito, Takashi; Yamashita, Tomoya; Fujiwara, Hiroyasu; Nagamoto, Yukitaka; Matsuoka, Yuji; Suzuki, Hidekazu; Nishimura, Hirosuke; Terai, Hidetomi; Tamai, Katsuto; Tagami, Atsushi; Yamada, Shuta; Adachi, Satoshi; Watanabe, Kei; Katsumi, Keiichi; Ohashi, Masayuki; Shibuya, Yohei; Harimaya, Katsumi; Kawaguchi, Kohei; Yokoyama, Nobuhiko; Oishi, Hidekazu; Doi, Toshiro; Kimura, Atsushi; Inoue, Hirokazu; Inoue, Gen; Miyagi, Masayuki; Saito, Wataru; Nakano, Atsushi; Sakai, Daisuke; Nukaga, Tadashi; Ikegami, Shota; Shimizu, Masayuki; Futatsugi, Toshimasa; Ohtori, Seiji; Furuya, Takeo; Orita, Sumihisa; Imagama, Shiro; Ando, Kei; Kobayashi, Kazuyoshi; Kiyasu, Katsuhito; Murakami, Hideki; Yoshioka, Katsuhito; Seki, Shoji; Hongo, Michio; Kakutani, Kenichiro; Yurube, Takashi; Aoki, Yasuchika; Oshima, Masashi; Takahata, Masahiko; Iwata, Atsushi; Endo, Hirooki; Abe, Tetsuya; Tsukanishi, Toshinori; Nakanishi, Kazuyoshi; Watanabe, Kota; Hikata, Tomohiro; Suzuki, Satoshi; Isogai, Norihiro; Okada, Eijiro; Funao, Haruki; Ueda, Seiji; Shiono, Yuta; Nojiri, Kenya; Hosogane, Naobumi; Ishii, Ken

doi:10.1186/s12891-020-03452-6

Cited by 18 publications

(18 citation statements)

References 32 publications

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“…A retrospective comparative study with bisphosphonate showed a significantly higher union rate at 6 months in the teriparatide group and suggested that teriparatide could enhance fracture healing in OVCF [86]. Teriparatide also showed bet-ter results than bisphosphonate in preventing mechanical complications after posterior instrumented fusion for OVF [87].…”

Section: Medical Management Of Fracture Healingmentioning

confidence: 99%

Current Concepts in the Management of Osteoporotic Vertebral Fractures: A Narrative Review

et al. 2020

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Vertebral fractures are the most common type of osteoporotic fracture and can increase morbidity and mortality. To date, the guidelines for managing osteoporotic vertebral fractures (OVFs) are limited in quantity and quality, and there is no gold standard treatment for these fractures. Conservative treatment is considered the primary treatment option for OVFs and includes pain relief through shortterm bed rest, analgesics, antiosteoporotic drugs, exercise, and braces. Studies on vertebral augmentation (VA) including vertebroplasty and kyphoplasty have been widely reported, but there is still debate and controversy regarding the effectiveness of VA when compared with conservative treatment, and the routine use of VA for OVF is not supported by current evidence. Although most OVFs heal well, approximately 15%–35% of patients with unstable fractures, chronic intractable back pain, severely collapsed vertebra (leading to neurological deficits and kyphosis), or chronic pseudarthrosis frequently require surgery. Given that there is no single technique for optimizing surgical outcomes in OVFs, tailored surgical techniques are needed. Surgeons need to pay attention to advances in osteoporotic spinal surgery and should be open to novel thoughts and techniques. Prevention and management of osteoporosis is the key element in reducing the risk of subsequent OVFs. Bisphosphonates and teriparatide are mainstay drugs for improving fracture healing in OVF. The effects of bisphosphonates on fracture healing have not been clinically evaluated. The intermittent administration of teriparatide significantly enhanced spinal fusion and fracture healing and reduced mortality risk. Based on the current literature, there is still a lack of standard management strategies for OVF. There is a need for greater efforts through multimodal approaches including conservative treatment, surgery, osteoporosis treatment, and drugs that promote fracture healing to improve the quality of the guidelines.

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Section: Medical Management Of Fracture Healingmentioning

confidence: 99%

Current Concepts in the Management of Osteoporotic Vertebral Fractures: A Narrative Review

et al. 2020

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“…However, there was no difference in screw loosening, subsequent vertebral fracture, VAS, or ODI. 38 Such findings heavily affected the preferred therapy algorithm, especially when bisphosphonates, including ZOL, are still the first-line choice. However, the detailed instructions and practical application of TPTD vary from study to study.…”

Section: Discussionmentioning

confidence: 99%

The Effect of Daily Teriparatide versus One-Time Annually Zoledronic Acid Administration After Transforaminal Lumbar Interbody Fusion in Osteoporotic Patients

Wang¹,

Chen²,

Chen³

et al. 2021

CIA

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The research aimed to compare the therapeutic effect of teriparatide (TPTD) and zoledronic acid (ZOL) therapy on bone formation and spinal fusion in patients with osteoporosis (OP) who underwent transforaminal lumbar interbody fusion (TLIF). Methods: On the basis of different anti-OP treatment options, the TPTD group was treated daily with TPTD (20 μg. ih. qd) for at least 6 months, while the ZOL group was treated with a single dose of ZOL (5 mg. ivgtt. st) postoperatively. The visual analogue scale (VAS), Oswestry Disability Index (ODI), bone mineral density (BMD), and concentration of bone turnover markers before, 6, and 12 months after surgery were evaluated. X-ray and threedimensional computed tomography scans were performed at 6 and 12 months postoperatively to assess interbody fusion. Results: The number of patients in the TPTD and ZOL groups was 29 and 38 patients, respectively. The VAS and ODI scores in both groups were significantly reduced at 6 and 12 months after TLIF. Compared with that of baseline, the lumbar spine BMD of TPTD patients increased significantly from 0.716±0.137 g/cm 2 to 0.745±0.124 g/cm 2 and 0.795±0.123 g/cm 2 at 6 and 12 months, respectively, and was significantly higher than that of the ZOL group at 12 months (0.720±0.128 g/cm 2 ). The bone formation marker, P1NP, in the TPTD group increased significantly (145.48±66.64 ng/mL and 119.55±88.27 ng/mL) compared with baseline (44.67 ±25.15 ng/mL) and in the ZOL group (28.82±19.76 ng/mL and 29.94±20.67 ng/mL) at 6 and 12 months, respectively. The fusion rates in the TPTD and ZOL groups were 57% and 45% at 6 months, without statistical significance. However, TPTD had a more statistically significant positive influence on fusion rate than ZOL at 12 months (86% vs 70%). Conclusion: TPTD was more efficient than ZOL in bone formation and spinal fusion in OP patients who underwent TLIF.

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“…Second, poor bone health commonly manifests as osteoporosis,41,42 malnutrition, or obesity 43. Teriparatide use has been shown to decrease rates of pseudarthrosis in patients with osteoporosis, though this study was in vertebral fractures of all levels 41. Third, an inability to mount an adequate inflammatory response has also been cited in rheumatologic conditions requiring chronic steroid use 44.…”

Section: Methodsmentioning

confidence: 99%

Pseudarthrosis of the Cervical Spine

Zuckerman

Devin

2021

Clinical Spine Surgery: A Spine Publication

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Pseudarthrosis of the cervical spine represents a common and challenging problem for spine surgeons. Rates vary greatly from as low as 0%-20% to > 60% and depend heavily on patient factors, approach, and number of levels. While some patients remain asymptomatic from pseudarthrosis, many require revision surgery due to instability, continued neck pain, or radiculopathy/myelopathy. We aimed to provide a practical, narrative review of cervical pseudarthrosis to address the following areas: (1) definitions, (2) incidence, (3) risk factors, (4) presentation and workup, (5) treatment decision-making, and (6) postoperative care. It is our hope the current review provides a concise summary for how to diagnose and treat challenging cervical nonunions.

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Effect of bisphosphonates or teriparatide on mechanical complications after posterior instrumented fusion for osteoporotic vertebral fracture: a multi-center retrospective study

Cited by 18 publications

References 32 publications

Current Concepts in the Management of Osteoporotic Vertebral Fractures: A Narrative Review

Current Concepts in the Management of Osteoporotic Vertebral Fractures: A Narrative Review

The Effect of Daily Teriparatide versus One-Time Annually Zoledronic Acid Administration After Transforaminal Lumbar Interbody Fusion in Osteoporotic Patients

Pseudarthrosis of the Cervical Spine

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