Teriparatide Accelerates Lumbar Posterolateral Fusion in Women With Postmenopausal Osteoporosis

Ohtori, Seiji; Inoue, Gen; Orita, Sumihisa; Yamauchi, Kazuyo; Eguchi, Yawara; Ochiai, Nobuyasu; Kishida, Shunji; Kuniyoshi, Kazuki; Aoki, Yasuchika; Nakamura, Junichi; Ishikawa, Tetsuhiro; Miyagi, Masayuki; Kamoda, Hiroto; Suzuki, Miyako; Kubota, Go; Sakuma, Yoshihiro; Oikawa, Yasuhiro; Inage, Kazuhide; Sainoh, Takeshi; Takaso, Masashi; Ozawa, Tomoyuki; Takahashi, Kazuhisa; Toyone, Tomoaki

doi:10.1097/brs.0b013e31826ca2a8

Cited by 175 publications

(121 citation statements)

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“…The role of bisphosphonates in spinal fusion is controversial in the literature with some reports suggesting inhibition of fusion, while others state the opposite [34][35][36][37][38][39][40][41][42][43][44][45][46]. In contrast, both animal and clinical studies seem to suggest that teriparatide [recombinant human parathyroid hormone (rhPTH)] enhances fusion [47][48][49][50]. Unless there are medical contraindications, we encourage our patients to be on teriparatide several months before surgery and up to 2 years after surgery and have anecdotally observed encouraging results.…”

Section: Suggestions To Minimize Pjkmentioning

confidence: 69%

Proximal junctional kyphosis following adult spinal deformity surgery

2014

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Section: Suggestions To Minimize Pjkmentioning

confidence: 69%

Proximal junctional kyphosis following adult spinal deformity surgery

2014

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“…However, several clinical case reports, case series, and randomized, controlled studies have indicated that PTH may enhance bone healing, particularly in the distal radius, pelvis, and spine [104][105][106][107][108][109][110][111].…”

Section: Clinical Evidencementioning

confidence: 96%

“…Patients were started on either bisphosphonate or teriparatide 2 months prior to surgery and continued treatment for 8 months postoperatively. Based on periodic follow-up radiographs, accelerated fusion was noted with teriparatide compared to bisphosphonate, and compared to both bisphosphonates and unmedicated controls, the teriparatide group had decreased screw loosening and increased bone mass [110,111].…”

Section: Clinical Evidencementioning

confidence: 99%

Effect of osteoporosis medications on fracture healing

et al. 2015

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Antiosteoporotic medications are often used to concurrently treat a patient's fragility fractures and underlying osteoporosis. This review evaluates the existing literature from animal and clinical models to determine these drugs' effects on fracture healing. The data suggest that these medications may enhance bone healing, yet more thorough prospective studies are warranted. Pharmacologic agents that influence bone remodeling are an essential component of osteoporosis management. Because many patients are first diagnosed with osteoporosis when presenting with a fragility fracture, it is critical to understand how osteoporotic medications influence fracture healing. Vitamin D and its analogs are essential for the mineralization of the callus and may also play a role in callus formation and remodeling that enhances biomechanical strength. In animal models, antiresorptive medications, including bisphosphonates, denosumab, calcitonin, estrogen, and raloxifene, do not impede endochondral fracture healing but may delay repair due to impaired remodeling. Although bisphosphonates and denosumab delay callus remodeling, they increase callus volume and result in unaltered biomechanical properties. Calcitonin increases cartilage formation and callus maturation, resulting in improved biomechanical properties. Parathyroid hormone, an anabolic agent, has demonstrated promise in animal models, resulting in accelerated healing with increased callus volume and density, more rapid remodeling to mature bone, and improved biomechanical properties. Clinical data with parathyroid hormone have demonstrated enhanced healing in distal radius and pelvic fractures as well as postoperatively following spine surgery. Strontium ranelate, which may have both antiresorptive and anabolic properties, affects fracture healing differently in normal and osteoporotic bone. While there is no effect in normal bone, in osteoporotic bone, strontium ranelate increases callus bone formation, maturity, and mineralization; forms greater and denser trabeculae; and improves biomechanical properties. Further clinical studies with these medications are needed to fully understand their effects on fracture healing in order to simultaneously treat fragility fractures and underlying osteoporosis.

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“…Several case reports have demonstrated enhanced healing with teriparatide treatment after the patient experienced delayed fracture healing [30,31]. Teriparatide may also enhance healing of lumbar fusion [32].…”

Section: Use Of Osteoporosis Medications During Bone Healingmentioning

confidence: 98%