Teriparatide increases the insertional torque of pedicle screws during fusion surgery in patients with postmenopausal osteoporosis

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>The object of this study was to examine the efficacy of preoperative teriparatide treatment for increasing the insertional torque of pedicle screws during fusion surgery in postmenopausal women with osteoporosis.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>Fusion surgery for the thoracic and/or lumbar spine was performed in 29 postmenopausal women with osteoporosis aged 65–82 years (mean 72.2 years). The patients were divided into 2 groups based on whether they were treated with teriparatide (n = 13) or not (n = 16) before the surgery. In the teriparatide-treated group, patients received preoperative teriparatide therapy as either a daily (20 μg/day, n = 7) or a weekly (56.5 μg/week, n = 6) injection for a mean of 61.4 days and a minimum of 31 days. During surgery, the insertional torque was measured in 212 screws inserted from T-7 to L-5 and compared between the 2 groups. The correlation between the insertional torque and the duration of preoperative teriparatide treatment was also investigated.</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>The mean insertional torque value in the teriparatide group was 1.28 ± 0.42 Nm, which was significantly higher than in the control group (1.08 ± 0.52 Nm, p &lt; 0.01). There was no significant difference between the daily and the weekly teriparatide groups with respect to mean insertional torque value (1.34 ± 0.50 Nm and 1.18 ± 0.43 Nm, respectively, p = 0.07). There was negligible correlation between insertional torque and duration of preoperative teriparatide treatment (r<jats:sup>2</jats:sup> = 0.05, p &lt; 0.01).</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Teriparatide injections beginning at least 1 month prior to surgery were effective in increasing the insertional torque of pedicle screws during surgery in patients with postmenopausal osteoporosis. Preoperative teriparatide treatment might be an option for maximizing the purchase of the pedicle screws to the bone at the time of fusion surgery.</jats:p></jats:sec>

Bisphosphonate-associated atypical sub-trochanteric femur fractures: Paired bone biopsy quantitative histomorphometry before and after teriparatide administration

“…The data does suggest that teriparatide might increase bone turnover in this study group, even in those with absent bone turnover at baseline. Our data does not provide any evidence that would indicate that teriparatide would heal an early cortical fracture detected by an early radiological examination, though fracture healing has been described in clinical reports and case series with teriparatide use [43][44][45][46][47]. Our data does call for larger studies of teriparatide or future bone anabolics in this population, especially in those with non-displaced fractures.…”

Incidence of Osteoporosis-Related Complications Following Posterior Lumbar Fusion

“…As previously mentioned, there have been many advances in medical management, 3,4 biologics and bone substitutes, 5,6 and recognition and treatment of vitamin D deficiency. 7 Although medical records were reviewed to exclude some diagnoses, we did not include an analysis of medical therapies or other treatments aimed at low bone density.…”

Reducing the risk of impaired bone apposition to titanium screws with the use of fibroblast growth factor-2−apatite composite layer coating

“…It is feasible to apply the FGF-2−apatite composite layer to internal fixation screws, which have varied stability at the screw–bone interface depending on the quantity, quality, and regeneration of bone surrounding the screw [30–32]. The stability of the screw−bone interface is characterized by the extraction torque and pull-out resistance [33].…”