Clinical and radiological outcomes of denosumab and teriparatide treatment in elderly patients with osteoporotic spinal compression fracture without vertebroplasty

Abstract

Objective Vertebroplasty is a common treatment for osteoporotic spinal compression fractures, but it poses complication risk. Therefore, we investigated the clinical and radiological outcomes of conservative treatment using a combination of denosumab and teriparatide. Methods This study included 86 patients aged 75 or older who were diagnosed with osteoporotic spinal compression fracture from January 2011 to April 2021. The patients were then categorized into those who received denosumab and teriparatide combination treatment without vertebroplasty(group A) and those who received bisphosphonate treatment and underwent vertebroplasty (group B). Several parameters were analyzed: age, sex, underlying diseases, BMI, hospital stay, the time of ambulation start, BMD, VAS score, compression ratio, regional Cobb angle, and local kyphotic angle. Results As compared to group A, group B showed a relatively shorter hospital stay and time until starting ambulation, but without statistical significance. The VAS scores measured at the time of injury, post-treatment, 3months post-injury, and 1year post-injury did not show statistically significant differences between the groups. In contrast, the mean BMD measured at the time of injury and 1year post-injury demonstrated statistically significant improvements in group A compared to group B. The differences in the compression ratio, regional Cobb angle, and local kyphotic angle measured at the time of injury and 1year post-injury were not statistically significant. Conclusion Combination treatment without vertebroplasty did not show significant differences in either clinical or radiologic results compared to vertebroplasty cases. Therefore, denosumab and teriparatide combination treatment could be considered as an alternative option for osteoporotic spinal compression fracture patients. Keywords: Osteoporosis; Vertebral compression fracture; Vertebroplasty; Elderly patients; Bone density