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

Abstract

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.

Postoperative bisphosphonate do not significantly alter the fusion rate after lumbar spinal fusion: a meta-analysis

“…Compared with a previous meta-analysis [ 25 ], we compared more parameters to evaluate the effect of BP therapy on lumbar fusion surgery and obtained some new findings, which indicated that compared with controls, BPs can significantly reduce VCF, cage subsidence, and loosening of pedicle screws after lumbar fusion surgery. Although the quality of included studies was relatively high, but we should also take consider the limitations listed below.…”

“…Although several animal studies on spinal fusion have reported a positive effect of BPs [ 21 , 22 ], two recent clinical studies concluded that preoperative BPs had no effect on the nonunion rates [ 20 , 23 ], and one systematic review did not clearly determine whether BP therapy after surgery provided an added benefit after lumbar fusion surgery [ 24 ]. A recent meta-analysis has evaluated the effect of postoperative BPs on the fusion rate [ 25 ], but the major objective was comparing teriparatide and BPs, and the comparisons in this study were not sufficiently comprehensive.…”

Postoperative Bisphosphonate Do Not Significantly Alter The Fusion Rate After Lumbar Spinal Fusion: A Meta-Analysis

“…Compared with a previous meta-analysis [25], we compared more parameters to evaluate the effect of BP therapy on lumbar fusion surgery and obtained some new ndings, which indicated that compared with controls, BPs can signi cantly reduce VCF, cage subsidence and loosening of pedicle screws after lumbar fusion surgery. Although the quality of included studies was relatively high, but we should also take consider the limitations listed below.…”

“…Although several animal studies on spinal fusion have reported a positive effect of BPs [21,22], two recent clinical studies concluded that preoperative BPs had no effect on the nonunion rates [20,23], and one systematic review did not clearly determine whether BP therapy after surgery provided an added bene t after lumbar fusion surgery [24]. A recent meta-analysis has evaluated the effect of postoperative BPs on the fusion rate [25] , but the major objective was comparing teriparatide and BPs, and the comparisons in this study were not su ciently comprehensive.…”

Implantatversagen nach Instrumentierungen bei Osteoporose: Ursachen und Behandlungskonzepte

“…Für Teriparatid sind die Ergebnisse generell einheitlicher und schließen auch die Fusion ein, möglicherweise auf Basis des Wirkmechanismus der direkten Erhöhung des BMD. Es ergibt sich also ein positiveres Bild für die Nutzung von Teriparatid zur Verhinderung von mechanischen Komplikationen [11,12]. Mittlerweile findet auch zunehmend Denosumab, als Anti-RANKL-Antikörper, Anwendung in der Osteoporose-Therapie.…”