The effect of teriparatide to alleviate pain and to prevent vertebral collapse after fresh osteoporotic vertebral fracture

Abstract

Vertebral fracture is often seen in osteoporotic patients. Teriparatide is expected to promote bone union. Therefore, we evaluated the action of vertebral collapse prevention by administering teriparatide to vertebral fracture patients. Thirty-four patients with fresh vertebral fracture (48 vertebrae) participated in this study. They were administered either teriparatide (daily 20 µg/day or weekly 56.5 µg/week) or risedronate (17.5 mg/week): ten patients (20 vertebrae) received teriparatide daily (Daily group), 11 patients (15 vertebrae) received teriparatide weekly (Weekly group), and 13 patients (14 vertebrae) received risedronate (RIS group). We compared some laboratory examination items, visual analogue scale (VAS) of low back pain, vertebral collapse rate and local kyphotic angle, and the cleft frequency. In addition, we evaluated 22 vertebral fracture patients (24 vertebrae) who did not take any osteoporotic medicines (Control group). There was no significant difference in any of the scores at the start of treatment. At 8 and 12 weeks after the initial visit, VAS scores in the Daily and Weekly groups were significantly lower than in the RIS group (p < 0.05). At 8 and 12 weeks, the vertebral collapse rate and local kyphotic angle in the Daily group were significantly lower than in the RIS and Control groups (p < 0.01 and p < 0.05, respectively), and those in the Weekly group were significantly lower than in the Control group (p < 0.05). The cleft frequency in the Daily group was significantly lower than in the RIS group (p < 0.05). Teriparatide is promising for the prevention of vertebral collapse progression after vertebral fracture.

Current Role and Application of Teriparatide in Fracture Healing of Osteoporotic Patients: A Systematic Review

“…[283134] In spine fractures, teriparatide showed various effects on pain relief per weeks after trauma. [3536] Physical performances including Timed Up-and-Go (TUG) test and time to mobilization were significantly improved in the teriparatide group with fractures of the pelvis and pertrochanteric femur[29303133] but, other function scores such as disabilities of the arm, shoulder, and hand (DASH) and grip strength revealed no differences in fractures of proximal humerus and distal radius after teriparatide injection. [2834]…”

“…In contrast, the other study showed significant reduction of pain numerical scale within 8 or 12 weeks after trauma. [36]…”

Teriparatide relieves ovariectomy-induced hyperalgesia in rats, suggesting the involvement of functional regulation in primary sensory neurons by PTH-mediated signaling

“…In this study, we applied 2 pain-related behavioral tests-the plantar test (paw flick test, a test observing avoidance of heat stimulation) and the von Frey test (a test to evaluate hyperalgesia by observing avoidance of mechanical stimulation)-to OVX rats to experimentally evaluate whether or not TPTD exerts an antinociceptive effect on this osteoporotic animal model, as has been observed in several clinical reports [15][16][17][18][19][20][21][22][23][24][25] . The plantar test showed that the withdrawal latency was gradually reduced in the OVX rats during the observation period compared with the Sham-vehicle group, confirming thermal hyperalgesia caused by OVX 8,10,11 .…”

Enhanced bone healing and decreased pain in sacral insufficiency fractures after teriparatide treatment: retrospective clinical-based observational study

“…In the present case series, the major symptoms of SIFs, which were low back or buttock pain, rapidly decreased after 1 month of treatment with TPTD. Several studies have demonstrated low back pain from vertebral fracture in patients with osteoporosis to be reduced with TPTD treatment (14)(15)(16)(17)(18). A meta-analysis showed that TPTD significantly reduced the risk of moderate or severe back pain compared to placebo, alendronate, or hormone replacement therapy in the patients with osteoporosis (15).…”