Effect of Teriparatide on Subsequent Vertebral Fractures after Instrumented Fusion Surgery for Osteoporotic Vertebral Fractures with Neurological Deficits

Abstract

Study Design Retrospective case review. Purpose To assess the incidence and effect of teriparatide (TP) on subsequent vertebral fractures following a long-instrumented fusion surgery for osteoporotic vertebral fractures (OVFs). Overview of Literature TP treatment may be a useful strategy for patients with OVFs treated with a long-instrumented surgery. Methods Overall, 47 patients who underwent long-instrumented fusion surgery (≥3 levels) for OVFs with neurological deficits between 2010 and 2013 were enrolled. The mean age of the subjects was 76 years; the study population comprised 20 males and 27 females. The mean follow-up duration was 23 months. The average of fused vertebrae was 4.9. TP was used for 19 patients who comprised the TP group. The incidence of subsequent VFs was estimated with Kaplan–Meier analyses and compared between the TP and non-TP groups using the log-rank test. Risk factors were evaluated using a Cox proportional hazards model. Results A total of 38% (18/47 cases) of the subjects were identified with subsequent VFs. There were no significant differences in the age, sex, fused levels, presence of prevalent fractures, and correction loss of the two groups. The occurrence of subsequent VFs was lower in the TP group than in the non-TP group (16% vs. 54%, p =0.014). The log-rank test revealed that the TP treatment significantly reduced the risk of subsequent VFs ( p =0.048). A Cox proportional hazards model revealed that preoperative TP treatment is only a protective factor of subsequent VFs after instrumented fusion surgery for OVFs (hazard ratio, 0.281; p =0.047). Conclusions In this retrospective study, pre- and postoperative TP treatment significantly reduced the incidence of subsequent VFs after instrumented fusion surgery for OVFs. A prospective randomized study is warranted to determine the efficacy of TP treatments.

Effect of Bisphosphonates or Teriparatide on Mechanical Complications after Posterior Instrumented Fusion for Osteoporotic Vertebral Fracture: A Multi-center Retrospective Study

“…Previous studies have demonstrated the superiority of TP over BP in patients who have undergone conservative treatment for OVF according to bone union rates [12][13][14]. Other studies have shown the positive effects of TP on bony fusion after spinal fusion or correction surgery [15][16][17][18][19][20]. TP has bone anabolic ability and can reduce the chance of screw loosening, and so the use of BP may effectively enhance spinal fusion and reduce implant failure and/ or subsequent vertebral fracture in comparison with surgery [16,19,20].…”

“…Other studies have shown the positive effects of TP on bony fusion after spinal fusion or correction surgery [15][16][17][18][19][20]. TP has bone anabolic ability and can reduce the chance of screw loosening, and so the use of BP may effectively enhance spinal fusion and reduce implant failure and/ or subsequent vertebral fracture in comparison with surgery [16,19,20]. However, there is limited literature on the relationship between administration of these agents and mechanical complications after posterior fusion surgery for OVF.…”

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

“…Previous studies have demonstrated the superiority of TP over BP in patients who have undergone conservative treatment for OVF according to bone union rates [14][15][16]. Other studies have shown the positive effects of TP on bony fusion after spinal fusion or correction surgery [17][18][19][20][21][22]. TP has bone anabolic ability and can reduce the chance of screw loosening, and so the use of TP may effectively enhance spinal fusion and reduce implant failure and/ or subsequent vertebral fracture in comparison with surgery [17][18][19][20][21][22].…”

Effect of Bisphosphonates or Teriparatide on Mechanical Complications after Posterior Instrumented Fusion for Osteoporotic Vertebral Fracture: A Multi-center Retrospective Study

“…Previous studies have demonstrated the superiority of TP over BP in patients who have undergone conservative treatment for OVF according to bone union rates [13][14][15]. Other studies have shown the positive effects of TP on bony fusion after spinal fusion or correction surgery [16][17][18][19][20][21]. TP has bone anabolic ability and can reduce the chance of screw loosening, and so the use of TP may effectively enhance spinal fusion and reduce implant failure and/ or subsequent vertebral fracture in comparison with surgery [16][17][18][19][20][21].…”

“…Other studies have shown the positive effects of TP on bony fusion after spinal fusion or correction surgery [16][17][18][19][20][21]. TP has bone anabolic ability and can reduce the chance of screw loosening, and so the use of TP may effectively enhance spinal fusion and reduce implant failure and/ or subsequent vertebral fracture in comparison with surgery [16][17][18][19][20][21]. However, there is limited literature on the relationship between administration of these agents and mechanical complications after posterior fusion surgery for OVF.…”