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Teriparatide Accelerates Lumbar Posterolateral Fusion in Women With Postmenopausal Osteoporosis

2012; Lippincott Williams & Wilkins; Volume: 37; Issue: 23 Linguagem: Inglês

10.1097/brs.0b013e31826ca2a8

1528-1159

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

Bone and Joint Diseases

In Brief Study Design. Prospective trial. Objective. To examine the clinical efficacy of teriparatide for bone union after instrumented lumbar posterolateral fusion using local bone grafting in women with postmenopausal osteoporosis. Summary of Background Data. Intermittent parathyroid hormone (PTH) treatment increases bone mass and reduces the risk for osteoporotic vertebral fractures. Recombinant human PTH (1–34) has already been approved as a treatment for severe osteoporosis. Preclinical data support the efficacy of PTH for lumbar spinal fusion. However, clinical results of PTH for spinal fusion have not yet been reported. Methods. Fifty-seven women with osteoporosis diagnosed with degenerative spondylolisthesis were divided into 2 treatment groups, a teriparatide group (n = 29; daily subcutaneous injection of 20 μg of teriparatide) and a bisphosphonate group (n = 28; weekly oral administration of 17.5 mg of risedronate). All patients underwent decompression and 1- or 2-level instrumented posterolateral fusion with a local bone graft. Fusion rate, duration of bone union, and pain scores were evaluated 1 year after surgery. Results. Pain scores improved after surgery; however, no significant difference was noted between the groups after surgery. The rate of bone union was 82% in the teriparatide group and 68% in the bisphosphonate group. Average duration of bone union was 8 months in the teriparatide group and 10 months in the bisphosphonate group. The rate of bone union and average of duration of bone union in the teriparatide group patients were significantly superior to those in the bisphosphonate group. Conclusion. Daily subcutaneous injection of teriparatide for bone union using local bone grafting after instrumented lumbar posterolateral fusion in women with postmenopausal osteoporosis was more effective than oral administration of bisphosphonate. 57 osteoporotic postmenopausal women with degenerative spondylolisthesis underwent instrumented posterolateral fusion surgery with 10-month daily subcutaneous injection of teriparatide. This teriparatide treatment significantly improved bone union after surgery compared with oral administration of bisphosphonate.