Risk of New Vertebral Fracture and Combination Therapy with Zoledronic Acid and Teriparatide in Diabetic Patients after Percutaneous Kyphoplasty

Zhang, Jian; Yan, Bin; Chen, Zhe; Zheng, Zhaomin; Yang, Changsheng

doi:10.31616/asj.2020.0282

Cited by 4 publications

(3 citation statements)

References 31 publications

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“…We will try some new BMD judgement parameters (e.g., HU value) to optimize the predictive performance when judging the risk of femoral head varus in our future studies [ 17 , 18 ]. In addition, we still believe that the result of this study do not deny the significance of anti-osteoporosis therapy on the optimization of fixation stability [ 42 , 43 ].…”

Section: Discussionmentioning

confidence: 99%

Changes in nail position and antirotation blade angles on the risk of femoral head varus in PFNA fixed patients: a clinical review and comprehensive biomechanical research

Huang,

Xu,

et al. 2024

Eur J Med Res

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Background Femoral head varus triggers poor clinical prognosis in intertrochanteric fracture patients with proximal femoral nail antirotation (PFNA) fixation. Studies present that changes in nail position and screw insertion angles will affect fixation stability, but the biomechanical significance of these factors on the risk of femoral head varus has yet to be identified in PFNA fixed patients. Methods Clinical data in PFNA fixed intertrochanteric fracture patients have been reviewed, the relative position of intermedullary nail has been judged in the instant postoperative lateral radiography. Regression analyses have been performed to identify the effect of this factor on femoral head varus. Corresponding biomechanical mechanism has been identified by numerical mechanical simulations. Results A clinical review revealed that ventral side nail insertion can trigger higher risk of femoral head varus, corresponding numerical mechanical simulations also recorded poor fixation stability in models with ventral side nail insertion, and changes in the trajectory of anti-rotation blade will not obviously affect this tendency. Conclusions Ventral side insertion of intramedullary nail can trigger higher risk of femoral head varus in PFNA fixed patients by deteriorating the instant postoperative biomechanical environment, and changes in blade trajectory cannot change this tendency biomechanically. Therefore, this nail position should be adjusted to optimize patients’ prognosis.

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Section: Discussionmentioning

confidence: 99%

Changes in nail position and antirotation blade angles on the risk of femoral head varus in PFNA fixed patients: a clinical review and comprehensive biomechanical research

Huang,

Xu,

et al. 2024

Eur J Med Res

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“…patients with noticeable regional HU value differences) should be considered high-risk patients for AVF. The corresponding strategies, such as the use of low-stiffness calcium phosphate cement, postoperative combination therapy of osteoporosis with zoledronic acid and teriparatide, frequent clinical follow-ups, and prophylactic vertebroplasty, could be considered for these patients to reduce the risk of AVF 48 – 50 .…”

Section: Discussionmentioning

confidence: 99%

Regional differences in bone mineral density biomechanically induce a higher risk of adjacent vertebral fracture after percutaneous vertebroplasty: a case-comparative study

Xie²,

Sun

et al. 2023

International Journal of Surgery

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Background: Adjacent vertebral fracture (AVF) is a frequently observed complication after percutaneous vertebroplasty (PVP) in patients with osteoporotic vertebral compressive fracture. Biomechanical deterioration initially induces a higher risk of AVF. Studies demonstrated that the aggravation of regional differences in the elastic modulus of different components might deteriorate the local biomechanical environment and increase the risk of structural failure. Considering the existence of intravertebral regional differences in bone mineral density (BMD) (i.e. elastic modulus), it was hypothesized in the present study that higher intravertebral BMD differences may induce a higher risk of AVF biomechanically. Materials and Methods: The radiographic and demographic data of osteoporotic vertebral compressive fracture patients treated using PVP were reviewed in the present study. The patients were divided into two groups: those with AVF and those without AVF. The Hounsfield unit (HU) values of transverse planes from the superior to the inferior bony endplate were measured, and the differences between the highest and lowest HU values of these planes were considered the regional differences of the HU value. The data from patients with and without AVF were compared, and the independent risk factors were identified through regression analysis. PVP with different grades of regional differences in the elastic modulus of the adjacent vertebral body was simulated using a previously constructed and validated lumbar finite element model, and the biomechanical indicators related to AVF were computed and recorded in surgical models. Results: Clinical data on 103 patients were collected in this study (with an average follow-up period of 24.1 months). The radiographic review revealed that AVF patients present a significantly higher regional difference in the HU value and that the increase in the regional difference of the HU value was an independent risk factor for AVF. In addition, numerical mechanical simulations recorded a stress concentration tendency (the higher maximum equivalent stress value) in the adjacent vertebral cancellous bone, with a stepwise aggravation of the adjacent cancellous bony regional stiffness differences. Conclusions: The aggravation of regional BMD differences induces a higher risk of AVF after PVP surgery through a deterioration of the local biomechanical environment. The maximum differences in the HU value of the adjacent cancellous bone should, therefore, be measured routinely to better predict the risk of AVF. Patients with noticeable regional BMD differences should be considered at high risk for AVF, and greater attention must be paid to these patients to reduce the risk of AVF. Evidence grade: Level III b.

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“…There is a lack of stronger evidence in the treatment of osteoporotic fracture. In a recent study on the risk of recurrent fractures in diabetic patients with OVCF, zoledronic acid combined with teriparatide can significantly reduce the rate of re-current fractures compared with zoledronic acid after PKP [12]. This study is to observe and compare the clinical effect of zoledronic acid, teriparatide, zoledronic acid combined with teriparatide in the prevention of recurrent fracture risk in elderly patients with OVCF after PKP, so as to further unify the data of fracture risk base, and find a better treatment scheme for elderly patients with OVCF.…”

Section: Introductionmentioning

confidence: 99%

The Clinical Effect of Zoledronic Acid Combined with Teriparatide in Perverting Recurrent Fracture of Osteoporotic Vertebral Compressive Fractures in the Elderly after Percutaneous Kyphoplasty

Zhao¹,

Yang²,

Zhang³

2021

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Background: Zoledronic acid and teriparatide have been proved to be effective in improving bone metabolism and preventing fractures, but there is no clear clinical report on the efficacy of their combined application. Purpose: To discuss the clinical effect of zoledronic acid combined with teriparatide in perverting recurrent fracture of osteoporotic vertebral compressive fractures (OVCF) in the elderly after percutaneous kyphoplasty (PKP). Method: A randomized clinical trial was conducted at the First Affiliated Hospital of Hebei North University in China from September 2018 and September 2019. A total of 60 patients with OVCF were enrolled in the study (zoledronic acid: 20 cases; teriparatide: 20 cases; zoledronic acid + teriparatide: 20 cases). Observe and compare the changes of bone mineral density (BMD), pro-collagen type I N-terminal propeptide (PINP) and cross-linked C-terminal telopeptide of type I collagen (β-CTX) before surgery, 6 months and 1 year after surgery. At the same time, secondary fracture events and adverse reaction events were recorded during the follow-up period. Results: After normalized treatment, the bone metabolism indexes of PINP and β-CTX were improved and BMD was increased in three groups. Adverse Reactions: There was no statistical significance in the incidence of fever, gastrointestinal reactions and myalgia among the three groups (P > 0.05). The incidence of recurrent fractures in group A was higher than that in group C (P < 0.05), but there was no significant difference between group B and group C (P > 0.05). Conclusion: Zoledronic

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Risk of New Vertebral Fracture and Combination Therapy with Zoledronic Acid and Teriparatide in Diabetic Patients after Percutaneous Kyphoplasty

Cited by 4 publications

References 31 publications

Changes in nail position and antirotation blade angles on the risk of femoral head varus in PFNA fixed patients: a clinical review and comprehensive biomechanical research

Changes in nail position and antirotation blade angles on the risk of femoral head varus in PFNA fixed patients: a clinical review and comprehensive biomechanical research

Regional differences in bone mineral density biomechanically induce a higher risk of adjacent vertebral fracture after percutaneous vertebroplasty: a case-comparative study

The Clinical Effect of Zoledronic Acid Combined with Teriparatide in Perverting Recurrent Fracture of Osteoporotic Vertebral Compressive Fractures in the Elderly after Percutaneous Kyphoplasty

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