Teriparatide Associated with Fewer Refractures and Higher Body Heights of Cemented Vertebrae after Vertebroplasty: A Matched Cohort Study

Abstract

Refracture of cemented vertebrae occurs commonly after vertebroplasty (Vp) for osteoporotic vertebral compression fracture (OVCF). It can result in severe pain or neurological deficit, but no preventive medication is available. Owing to the bone anabolic benefits of teriparatide (TP), this study was aimed to compare the outcomes of cemented vertebrae with tp to those without tp. patients who received Vp for OVCF with at least 1 year follow-up were included. The anterior body height (ABH) and middle body height (MBH) and kyphotic angle (KA) were measured before VP and 1 week and at least 1 year after VP. Refracture was defined as a 15% decrease in ABH or MBH and 8° decrease in KA compared with those at postoperative 1 week. The clinical outcomes were evaluated. 35 VP procedures in 21 patients treated with TP (TP group), and, matched to that, 29 out of 133 patients treated with VP alone (VP group) were included. One year after VP, ABH and MBH were significantly greater, except KA, in the TP group (Vp group vs. tp group: KA − 4.97° ± 12.1 vs. −2.85° ± 12.21°, p = 0.462, ABH 1.56 ± 0.48 cm vs. 1.84 ± 0.56 cm, p = 0.027, MBH 1.49 ± 0.39 cm vs. 1.73 ± 0.41 cm, p = 0.017). The refracture rates of KA, ABH, and MBH were significantly lower in the TP group (VP group vs. TP group: KA 42.11% vs.8.57%, p < 0.001; ABH 76.32% vs. 28.57%, p < 0.0001; MBH 76.32% vs. 28.57%, p < 0.0001). In single-level subgroup comparison, TP was associated with better improvement of pain VAS and better radiological outcomes. TP was associated with higher BHs and fewer refractures than VP alone, with comparable clinical outcomes 1 year after VP. TP may be associated with better improvement of pain VAS in those with single-level VP procedure. Higher BH was due to the better maintenance effect of TP. Refracture of cemented vertebrae after vertebroplasty (VP) occurs frequently in patients with osteoporotic vertebral compression fracture (OVCF). Different studies have reported different incidences of refracture 1-6. Refracture incidence ranged from 0.56% to 76% depending on the definition and follow-up period. Some refractures resulted in severe pain, instability, and even neurological deficits requiring further interventions 2,7-9. Kyphoplasty (KP) with an intravertebral reduction device (IRD) has been reported as a solution to prevent refracture with stronger anterior mechanical support 6. However, after VP, no medical solution exists so far. Teriparatide (TP) is the recombinant human parathyroid hormone (1-34) that increases bone mass 10,11 and decreases the risk of new vertebral fracture in patients with osteoporosis 12,13. Its antiosteoporosis effects depend on the enhancement of osteoblast formation 14 and prevention of osteoblast apoptosis 15. Owing to the anabolic effect, TP had been used to promote the process of bone healing after fracture 11,16-28. For fractures without internal implant fixation, TP was beneficial for nonweight-bearing regions 22,28 but not for weight-bearing regions 25. The role of TP is very controversial for fractures i...

Development and Internal Validation of Supervised Machine Learning Algorithm for Predicting the Risk of Recollapse Following Minimally Invasive Kyphoplasty in Osteoporotic Vertebral Compression Fractures

“…Severe osteoporosis and obesity increased the risk of recollapse. In our study, low BMD T-scores and high BMI were found to be significant predictors of distinct recollapse and were similar to published conclusions ( 2 , 8 , 24 – 26 ). Systematically reviewing OVCFs treated with minimally invasive surgery, Klazen et al identified the critical role of BMD in recollapse ( 27 ).…”

Analysis of radiologic and clinical outcome in acute osteoporotic vertebral compression fracture: Single-agent teriparatide vs. teriparatide with subsequent vertebroplasty

“…A retrospective case-matched study comparing the outcomes of cemented vertebrae with TPTD to those without TPTD demonstrated the addition of TPTD to be associated with higher body height and fewer re-fractures than VP alone. 6 The current study compared TPTD with subsequent VP with TPTD therapy without VP and revealed fewer re-fractures in the V group (12%) than in the T group (5%). Ma et al.‘s real-world prospective cohort study proved that TPTD-only treatment was not inferior to alendronate with VP treatment.…”

Advances in Osteoporosis Therapy: Focus on Osteoanabolic Agents, Secondary Fracture Prevention, and Perioperative Bone Health

“…Other retrospective studies report the following: teriparatide after BKP is associated with fewer VCFs, increased spine BMD, better health-related quality of life scores, and less back pain versus patients receiving calcium and vitamin D [ 138 ]; teriparatide after BKP is associated with fewer VCFs versus control subjects who mostly received ALN [ 139 ]; and teriparatide after VP is associated with greater vertebral body height and reduced refracture rate versus VP without teriparatide [ 140 ].…”