Zoledronic acid infusion for lumbar interbody fusion in osteoporosis

Tu, Chao-Wei; Huang, Kuo-Feng; Hsu, Hsien-Ta; Li, Hung-Yu; Yang, Stephen Shei‐Dei; Chen, Ying-Chu

doi:10.1016/j.jss.2014.05.034

Cited by 58 publications

(59 citation statements)

References 20 publications

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“…Teriparatide was used in four studies. Zoledronic acid was given as a 5 mg dose three days prior to surgery in one study [8], two weeks after surgery as single dose in another study [9], and three days postoperatively and yearly thereafter in the final study [10]. Risedronate dose was 2.5 mg oral daily two months before and continued ten months after surgery in one study [11], 17.5 mg and given weekly starting two months before surgery and continued for eight months after surgery in another study [12], and started three months before surgery in the final study [13], however they did not track which patients received Risedronate versus Teriparatide postoperatively.…”

Section: Resultsmentioning

confidence: 99%

Bisphosphonate's and Intermittent Parathyroid Hormone's Effect on Human Spinal Fusion: A Systematic Review of the Literature

et al. 2017

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There has been a conscious effort to address osteoporosis in the aging population. As bisphosphonate and intermittent parathyroid hormone (PTH) therapy become more widely prescribed to treat osteoporosis, it is important to understand their effects on other physiologic processes, particularly the impact on spinal fusion. Despite early animal model studies and more recent clinical studies, the impact of these medications on spinal fusion is not fully understood. Previous animal studies suggest that bisphosphonate therapy resulted in inhibition of fusion mass with impeded maturity and an unknown effect on biomechanical strength. Prior animal studies demonstrate an improved fusion rate and fusion mass microstructure with the use of intermittent PTH. The purpose of this study was to determine if bisphosphonates and intermittent PTH treatment have impact on human spinal fusion. A systematic review of the literature published between 1980 and 2015 was conducted using major electronic databases. Studies reporting outcomes of human subjects undergoing 1, 2, or 3-level spinal fusion while receiving bisphosphonates and/or intermittent PTH treatment were included. The results of relevant human studies were analyzed for consensus on the effects of these medications in regards to spinal fusion. There were nine human studies evaluating the impact of these medications on spinal fusion. Improved fusion rates were noted in patients receiving bisphosphonates compared to control groups, and greater fusion rates in patients receiving PTH compared to control groups. Prior studies involving animal models found an improved fusion rate and fusion mass microstructure with the use of intermittent PTH. No significant complications were demonstrated in any study included in the analysis. Bisphosphonate use in humans may not be a deterrent to spinal fusion. Intermittent parathyroid use has shown early promise to increase fusion mass in both animal and human studies but further studies are needed to support routine use.

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Section: Resultsmentioning

confidence: 99%

Bisphosphonate's and Intermittent Parathyroid Hormone's Effect on Human Spinal Fusion: A Systematic Review of the Literature

et al. 2017

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“…The 2 studies evaluating zoledronic acid showed a lower fusion rate in 1 study, and a nonstatistically significant higher fusion rate in the other study. 18,19 This is not strong evidence in support of using zoledronic acid on patients with osteoporosis undergoing spinal fusion and thus some surgeons may decide to avoid it. The 2 studies evaluating teriparatide both show a significantly higher rate of fusion in patients treated with teriparatide, compared to risedronate and control groups.…”

Section: Discussionmentioning

confidence: 99%

A Systematic Review of Treatment Strategies for Degenerative Lumbar Spine Fusion Surgery in Patients With Osteoporosis

Fischer

Hanson

Eller

et al. 2016

Geriatr Orthop Surg Rehabil

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Purpose:To evaluate the current evidence in the literature on treatment strategies for degenerative lumbar spine fusion in patients with osteoporosis.Methods:A systematic review of the literature from 1950 to 2015.Results:The review of the literature yielded 15 studies on the effect of treatment options for osteoporosis on lumbar fusion rates. This study evaluated only degenerative lumbar spine conditions and excluded deformity patients. One study demonstrated an association between low bone mass as measured by Hounsfield units and lower fusion rates. Six studies evaluated perioperative medical treatment of osteoporosis and showed higher fusion rates in patients treated with alendronate and teriparatide. The strongest evidence was for perioperative teriparatide. Eight studies evaluated surgical treatment strategies in patients with osteoporosis and showed that cement augmentation of pedicle screws and expandable pedicle screws demonstrated improved fusion rates than traditional pedicle screws. The strongest evidence was for expandable pedicle screws.Conclusion:There are 15 articles evaluating osteoporosis in patients undergoing lumbar fusion and the highest level of evidence is for perioperative use of teriparatide.

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“…These studies in animals on the role of zoledronic acid in spinal fusion have yielded consistent results. Tu et al [20] retrospectively analyzed 64 patients with both degenerative lumbar spondylolisthesis and osteoporosis who underwent lumbar interbody fusion surgery with regard to the effects of zoledronic acid on spine fusion. Zoledronic acid lowered the incidence of final subsequent VCFs, pedicle screw loosening, cage subsidence, and improved the clinical outcomes.…”

Section: Discussionmentioning

confidence: 99%

Effects of zoledronic acid on bone fusion in osteoporotic patients after lumbar fusion

et al. 2015

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PURPOSE To explore the effects of zoledronic acid on the healing process in osteoporotic patients following spinal fusion in a randomized, placebo controlled, and triple-blinded study. METHODS Seventy-nine osteoporotic patients with single-level degenerative spondylolisthesis were randomly assigned to receive either zoledronic acid infusion (zoledronic acid group) or saline infusion (controls) after spinal fusion. Functional radiography and CT scans were used to evaluate fusion status. Bone formation was graded into 3 categories: Grade A (bridging bone bonding with adjacent vertebral bodies), Grade B (bridging bone bonding with either superior or inferior vertebral body), or Grade C (incomplete bony bridging). A solid fusion was defined as less than 5 degree of angular motion with Grade A or B bone formation. Adjacent vertebral compression fractures (VCF) were assessed on MRI at 12 months after surgery. Serum level of carboxy terminal cross-linked telopeptide of type I collagen (β-CTX) and amino-terminal propeptide of type I procollagen (PINP) was measured. Bone mineral density (BMD) was measured by DXA. Oswestry Disability Index (ODI) was used to assess the clinical outcomes. RESULTS Grade A or B bridging bone was more frequently observed in zoledronic acid group at 3, 6, and 9 months post-operation compared to the control group (p < 0.05). At 12-months postoperation, bridging bone and solid fusion were not significantly different between groups. No patients in zoledronic acid group showed aVCF, whereas 6 patients (17%) in the control group did (p < 0.05). Both β-CTX and PINP were suppressed in zoledronic acid group. BMD at femoral neck decreased rapidly and did not return to the preoperative level in the controls at 3 (−1.4%), 6 (−2.5%), and 12 (−0.8%) months after surgery. Zoledronic acid prevented this immobilization-induced bone loss and increased BMD. ODI showed the improved clinical outcomes compared with controls at 9 and 12 months post-surgery. CONCLUSION Treatment with zoledronic acid in osteoporotic patients with spinal fusion shortens the time to fusion, improves the fusion rate, prevents subsequent aVCFs, and improves clinical outcomes.

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Zoledronic acid infusion for lumbar interbody fusion in osteoporosis

Cited by 58 publications

References 20 publications

Bisphosphonate's and Intermittent Parathyroid Hormone's Effect on Human Spinal Fusion: A Systematic Review of the Literature

Bisphosphonate's and Intermittent Parathyroid Hormone's Effect on Human Spinal Fusion: A Systematic Review of the Literature

A Systematic Review of Treatment Strategies for Degenerative Lumbar Spine Fusion Surgery in Patients With Osteoporosis

Effects of zoledronic acid on bone fusion in osteoporotic patients after lumbar fusion

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Zoledronic acid infusion for lumbar interbody fusion in osteoporosis

Cited by 58 publications

References 20 publications

Bisphosphonate&apos;s and Intermittent Parathyroid Hormone&apos;s Effect on Human Spinal Fusion: A Systematic Review of the Literature

Bisphosphonate&apos;s and Intermittent Parathyroid Hormone&apos;s Effect on Human Spinal Fusion: A Systematic Review of the Literature

A Systematic Review of Treatment Strategies for Degenerative Lumbar Spine Fusion Surgery in Patients With Osteoporosis

Effects of zoledronic acid on bone fusion in osteoporotic patients after lumbar fusion

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Bisphosphonate's and Intermittent Parathyroid Hormone's Effect on Human Spinal Fusion: A Systematic Review of the Literature

Bisphosphonate's and Intermittent Parathyroid Hormone's Effect on Human Spinal Fusion: A Systematic Review of the Literature