Radiographic and functional outcomes of bisphosphonate use in lumbar fusion: a systematic review and meta-analysis of comparative studies

Fretes, Nickolas; Vellios, Evan E.; Sharma, Akshay; Ajiboye, Remi M.

doi:10.1007/s00586-019-06090-2

Cited by 16 publications

(4 citation statements)

References 25 publications

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“…14,15 However, the current level of evidence regarding the utility of these drug classes remains unclear, with the most recent systematic reviews on the subject lacking objective assessment of these agents' utility. 16,18,19 In addition, short-term versus long-term effects of these medical therapies on fusion remain unclear.…”

Section: Discussionmentioning

confidence: 99%

“…35 Denosumab, a monoclonal antibody that has been used as a fracture prophylactic in postmenopausal osteoporotic females, is another potential therapy. 19 It exerts its protective effects by binding to and inactivating RANKL. 9 RANKL has been demonstrated to increase osteoclast proliferation and activity, and the reduction of estrogen in older females has been shown to increase tissue exposure to RANKL, stimulating bone resorption.…”

Section: Bone Qualitymentioning

confidence: 99%

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Osteoporosis treatment in patients undergoing spinal fusion: a systematic review and meta-analysis

Govindarajan

Diaz

Perez-Roman

et al. 2021

Neurosurgical Focus

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OBJECTIVE Bisphosphonates and teriparatide are the most common therapies used in the treatment of osteoporosis. Their impact on fusion rates in osteoporotic patients following spinal fusion has yet to be concretely defined, with previous systematic reviews focusing heavily on bisphosphonates and lacking clinical insight on the utility of teriparatide. Herein the authors present an updated meta-analysis of the utility of both bisphosphonates and teriparatide in improving spinal fusion outcomes in osteoporotic patients. METHODS After a comprehensive search of the English-language literature in the PubMed and Embase databases, 11 clinical studies were included in the final qualitative and quantitative analyses. Of these studies, 9 investigated bisphosphonates, 7 investigated teriparatide, and 1 investigated a combination of teriparatide and denosumab. Odds ratios and 95% confidence intervals were calculated where appropriate. RESULTS A meta-analysis of the postoperative use of bisphosphonate demonstrated better odds of successful fusion as compared to that in controls during short-term monitoring (OR 3.33, 95% CI 1.72–6.42, p = 0.0003) but not long-term monitoring (p > 0.05). Bisphosphonate use was also shown to significantly reduce the likelihood of postoperative vertebral compression fracture (VCF; OR 0.07, 95% CI 0.01–0.59, p = 0.01) and significantly reduce Oswestry Disability Index scores (mean difference [MD] = −2.19, 95% CI −2.94 to −1.44, p < 0.00001) and visual analog scale pain scores (MD = −0.58, 95% CI −0.79 to −0.38, p < 0.00001). Teriparatide was found to significantly increase fusion rates at long-term postoperative periods as compared to rates after bisphosphonate therapy, with patients who received postoperative teriparatide therapy 2.05 times more likely to experience successful fusion (OR 2.05, 95% CI 1.17–3.59, p = 0.01). CONCLUSIONS The authors demonstrate the benefits of bisphosphonate and teriparatide therapy independently in accelerating fusion during the first 6 months after spinal fusion surgery in osteoporotic patients. In addition, they show that teriparatide may have superior benefits in spinal fusion during long-term monitoring as compared to those with bisphosphonates. Bisphosphonates may be better suited in preventing VCFs postoperatively in addition to minimizing postoperative disability and pain.

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Section: Discussionmentioning

confidence: 99%

Section: Bone Qualitymentioning

confidence: 99%

Osteoporosis treatment in patients undergoing spinal fusion: a systematic review and meta-analysis

Govindarajan

Diaz

Perez-Roman

et al. 2021

Neurosurgical Focus

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“…There are some other systemic reviews focusing on the same issue. Frestes et al reported insignificant difference in fusion rate between bisphosphonate and control group but bisphosphonate could reduce cage subsidence and vertebral fracture [12]. On the contrary, meta-analysis of Liu et al suggested that bisphosphonate may improve fusion rate [44], and the discrepancy may be due to inclusion of retrospective studies by Liu et al A recent meta-analysis comparing teriparatide, bisphosphate and control simultaneously concluded that teriparatide achieved better fusion rate than bisphosphonate and control, while there is no difference between bisphosphonate and control [13].…”

Section: Plos Onementioning

confidence: 96%

“…It inhibits the activity of osteoclast and increases bone stock by decreasing bone absorption [11]. While there are studies supporting the use of both agents [12,13], pooled evidence on their comparative efficacy is still lacking. To make up for such deficiency, this study performed a network meta-analysis to synthesize the current evidence on effectiveness of teriparatide and bisphosphonate in fusion surgery of thoracic and lumbar spine.…”

Section: Introductionmentioning

confidence: 99%

Effects of teriparatide and bisphosphonate on spinal fusion procedure: A systematic review and network meta-analysis

et al. 2020

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Background Giving patients anti-osteoporotic agents peri-operatively is a well-accepted strategy to increase fusion rate and prevent complications. The purpose of this study was to investigate effectiveness of teriparatide and bisphosphonate on fusion surgery of thoracic and lumbar spine. Methods We searched EMBASE and PubMed for randomized clinical trials (RCTs) and prospective comparative studies using teriparatide or bisphosphonate in peri-operative spinal fusion surgery. Our synthesized data of fusion rate, Oswestry disability index (ODI), and adverse event in contrast-based network meta-analysis. Pooled results were presented in risk ratio (RR) or mean difference (MD) with 95% confidence interval (CI). Results Our search hit eight RCTs and three prospective studies with 676 patients receiving spinal surgery. Pooled result showed that teriparatide+Denosumab leads to significantly higher fusion rate than placebo (RR, 2.84; 95% CI: 1.22 to 6.60) and bisphosphonate (RR, 2.59; 95% CI: 1.13 to 5.96). We did not observe significant finding among placebo, teriparatide, and bisphosphonate in the two network models.

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Osteoporosis Management with Focus on Spine

Kushchayeva

Lewiecki

2021

Image Guided Interventions of the Spine

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Radiographic and functional outcomes of bisphosphonate use in lumbar fusion: a systematic review and meta-analysis of comparative studies

Cited by 16 publications

References 25 publications

Osteoporosis treatment in patients undergoing spinal fusion: a systematic review and meta-analysis

Osteoporosis treatment in patients undergoing spinal fusion: a systematic review and meta-analysis

Effects of teriparatide and bisphosphonate on spinal fusion procedure: A systematic review and network meta-analysis

Osteoporosis Management with Focus on Spine

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