Prospective comparison of the therapeutic effect of teriparatide with that of combined vertebroplasty with antiresorptive agents for the treatment of new-onset adjacent vertebral compression fracture after percutaneous vertebroplasty

Abstract

SummaryMost post-vertebroplasty new-onset adjacent vertebral compression fractures (VCFs) occur within 2–3 months, and antiresorptive agents do not significantly reduce the risk of their occurrence. In opposite mechanism, teriparatide directly stimulates bone formation and improves bone strength and quality faster. The therapeutic effect of teriparatide is better than that of vertebroplasty combined with an antiresorptive treatment and is a potentially useful therapy for new-onset adjacent VCFs after vertebroplasty.IntroductionFollowing vertebroplasty, patients are at increased risk of new-onset adjacent-level VCFs. The therapeutic effect of antiresorptive agents is too slow, and they are associated with the risk of new VCFs. Teriparatide markedly increases bone formation and strength and reduces the incidence of new-onset VCFs. This prospective cohort study compared the therapeutic effects of teriparatide with those of combined vertebroplasty and an anti-resorber for treating new-onset adjacent VCFs after vertebroplasty.MethodsFifty patients with adjacent VCFs were randomly assigned to two groups: teriparatide only (group A) and additional vertebroplasty combined with an antiresorptive agent (group B). Relevant clinical data of the two groups were prospectively compared.ResultsThe 22 patients in group A were at higher risk of new VCFs than those in group B (22 patients); they were older and had more pre-existing fractures (p < 0.05). Patients treated with teriparatide had a significantly lower incidence of new-onset VCFs (odds ratio = 0.21; 95% confidence interval, 0.02–2.10). Teriparatide-mediated VCF reduction was 78.57%, which was markedly better than that of group B. The teriparatide group had a significant decrease in the visual analog scale and an increase in the Japanese Orthopedic Association low back pain score after 6 months of treatment (p < 0.05). The increase in lumbar spine BMD was marked in the teriparatide group (21.70% vs. 6.87%) after an 18-month treatment.ConclusionsTreatment of post-vertebroplasty adjacent VCFs with teriparatide (no new vertebroplasty) was more effective than that of repeated vertebroplasties combined with an anti-resorber.

At Least One Cyclic Teriparatide Administration Can Be Helpful to Delay Initial Onset of a New Osteoporotic Vertebral Compression Fracture

“…3 ), as a fully restored augmented vertebral body with appropriate sagittal alignment would be the goal of treatment. 21 , 22 Although teriparatide improves bone strength faster than other anti-resorptive agents, 7 , 8 , 23 , 24 all first new OVCFs developed within 1 year in VP patients ( Fig. 4 ).…”

“… 5 Teriparatide involves a direct mechanism that stimulates bone formation and improves bone strength faster than other anti-resorptive osteoporosis medications. 4 , 6 , 7 , 8 , 9 …”

Risk Factors for Chronic Low Back Pain in Adults: A Case Control Study Done in Sri Lanka

“…People with Anorexia nervosa have a low body mass index. Osteoporosis is a complication of Anorexia nervosa and is associated with a two to three times increase in vertebral fracture risk [29].Vertebral compression fractures (VCFs) are an important cause of low back pain [30]. People with increase in BMI may be having strong muscles and bones compared to people with low BMI and strong muscles and bones are important in preventing low back pain [10].…”

Fraturas osteoporóticas da coluna vertebral

“…Recentemente, um estudo de coorte prospectivo não observou diferenças estatísticas significativas entre CFC e PMMA em cifoplastia para pacientes com fratura dolorosa de vértebras osteoporóticas, não havendo diferença significativa entre o VAS-score, Mobility-score ou height-restoration. 57 Devido ao risco de fraturas adjacentes após a injeção do PMMA ou CFC, outra frente de estudos procura uma forma de reduzir os riscos de colapsos adjacentes. Sendo assim, Tseng et al 57 estudaram os agentes antirreabsorção como forma de prevenir as NFVO e perceberam que a maioria das novas fraturas ocorre dentro de dois a três meses e que os agentes antirreabsorção não protegem contra seu desenvolvimento.…”

“…57 Devido ao risco de fraturas adjacentes após a injeção do PMMA ou CFC, outra frente de estudos procura uma forma de reduzir os riscos de colapsos adjacentes. Sendo assim, Tseng et al 57 estudaram os agentes antirreabsorção como forma de prevenir as NFVO e perceberam que a maioria das novas fraturas ocorre dentro de dois a três meses e que os agentes antirreabsorção não protegem contra seu desenvolvimento. Contudo, em seu estudo, concluíram que o teriparatide aumentou em 21,7% a densidade mineral óssea, após 18 meses de tratamento, e a redução do risco de fraturas foi de 78,57%.…”