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

Yi-Shan Yang,Yi-Syue Tsou,Yung-Hsiao Chiang,Wen-Cheng Lo,Jiann-Her Lin

doi:10.1038/s41598-020-62869-0

Yi-Shan Yang, Yi-Syue Tsou + Show 3 more

Open Access

https://doi.org/10.1038/s41598-020-62869-0

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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.

Highlights

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]
No differences in age, gender, fracture level, body mass index (BMI), Bone marrow density (BMD), Oswestry disability index (ODI), preoperative and postoperative-1-week radiological parameters were observed between the TP and VP groups, but preoperative pain visual analogue scale (VAS) was reported more intense in TP group (Table 1)
The refracture rates of kyphotic angle (KA), anterior body height (ABH), and middle body height (MBH) were significantly lower in the TP group compared with the VP group 1 year after VP (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) (Table 2)

Summary

Introduction

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]. TP did not demonstrate benefits for enhancing bone-implant interface strength[17] and the fusion rates[20,23], it was associated with better clinical outcomes[16,20,23]. The local bone environment inside the fractured vertebrae was more complicated by cement after VP31. An interesting question arises: can TP help maintain the BH and prevent refracture under such a complicated bone environment in OCVF after VP?.

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