Use of Parathyroid Hormone and Rehabilitation Reduces Subsequent Vertebral Body Fractures after Balloon Kyphoplasty

Abstract

To evaluate the efficacy of our current prophylactic strategy by investigating the incidence of subsequent vertebral body fractures (SVBFs) following balloon kyphoplasty (BKP). Overview of Literature: Although extensive studies have investigated the risk factors for SVBFs after BKP, few have reported on postoperative therapies to prevent SVBFs and have evaluated their effectiveness. Methods: This study enrolled 273 patients who underwent an initial BKP. To treat osteoporosis, parathyroid hormone (PTH) administration was started 1-2 weeks before BKP and continued for at least 6 months postoperatively. Corsets were applied for 3 months after the procedure. Rehabilitative interventions, including hip range-of-motion training, muscle strengthening exercises, and motion/ posture instruction, were started from the preoperative assessment time point and resumed 3 hours postoperatively. Corsets were used in all patients. Therefore, no grouping based on corset use was performed. PTH was used in 180 patients, and they were divided into the following two groups: PTH user group and PTH nonuser group. Rehabilitative interventions were provided to all patients for a median duration of 17 days. Patients who underwent rehabilitative intervention for <17 and ≥17 days were included in the short-term and long-term intervention groups, respectively. The incidences of SVBFs for these four groups were compared. Results: SVBF occurred in 29 patients (10.6%). The SVBF incidence among patients who were prescribed all three prophylactic measures was 6.2%. The PTH user group had a significantly lower incidence of distant vertebral body fractures as compared to the PTH nonuser group. The long-term rehabilitation group had a significantly lower incidence of SVBFs and adjacent vertebral body fractures within 50 postoperative days than the short-term group. Conclusions: A 17-day or longer rehabilitative intervention may lower the risk of early adjacent vertebral body fractures, and the use of PTH may reduce the risk of distant vertebral body fractures.

Adjacent Fracture Rates Following Balloon Kyphoplasty in Osteoporotic Vertebral Compression Fractures: A Case Series

“…Bisphosphonate and Denosumab therapy were not associated with fracture. In a 2021 retrospective study, among a sample of 273 patients, PTH use was found to be associated with lower rates of remote, but not adjacent, fracture [ 17 ]. Although this study’s results did not show any significant change in vertebral fracture with Denosumab, a RANKL inhibitor, the sample only included five patients on Denosumab therapy, none of whom experienced an adjacent or remote fracture.…”

Application of Escherichia coli-Derived Recombinant Human Bone Morphogenic Protein-2 to Unstable Spinal Fractures

“…Ebata et al reported that teriparatide promoted bone formation at the fusion site and decreased bone resorption during the early postoperative period, as indicated by bone turnover markers [26]. Moreover, teriparatide can significantly reduce the risk of additional fractures after a spinal fracture [27]. Since the association between romosozumab and BMP-2 has not been reported, further studies are needed to evaluate the relationship between anabolic agents and BMP-2.…”

Advances in Osteoporosis Therapy: Focus on Osteoanabolic Agents, Secondary Fracture Prevention, and Perioperative Bone Health

“…Other retrospective studies report the following: teriparatide after BKP is associated with fewer VCFs, increased spine BMD, better health-related quality of life scores, and less back pain versus patients receiving calcium and vitamin D [ 138 ]; teriparatide after BKP is associated with fewer VCFs versus control subjects who mostly received ALN [ 139 ]; and teriparatide after VP is associated with greater vertebral body height and reduced refracture rate versus VP without teriparatide [ 140 ].…”