Effect of teriparatide (rh-PTH 1–34) versus bisphosphonate on the healing of osteoporotic vertebral compression fracture: A retrospective comparative study

BMC Musculoskeletal Disorders

Research Article

Norimasa Iwasaki¹  Tomoyuki Hashimoto²  Masahiro Kanayama²  Fumihiro Oha²  Akira Iwata³ 

[1] Department of Orthopaedic Surgery, Hokkaido University, N15 W7 Kita-ward, 060-8638, Sapporo, Hokkaido, Japan;Spine Center, Hakodate Central General Hospital, Hon-cho 33-2, 040-8585, Hakodate, Hokkaido, Japan;Spine Center, Hakodate Central General Hospital, Hon-cho 33-2, 040-8585, Hakodate, Hokkaido, Japan;Department of Orthopaedic Surgery, Hokkaido University, N15 W7 Kita-ward, 060-8638, Sapporo, Hokkaido, Japan;

关键词: Teriparatide;    Recombinant human parathyroid hormone 1–34;    Bisphosphonates;    Union rate;    Osteoporosis;    Osteoporotic vertebral compression fracture;   

DOI  :  10.1186/s12891-017-1509-1

 received in 2016-05-29, accepted in 2017-03-29,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundTeriparatide (recombinant human parathyroid hormone 1–34) is increasingly used for the treatment of severe osteoporosis because it stimulates bone formation and may potentially enhance fracture healing. The objective of this study was to investigate the effects of teriparatide versus a bisphosphonate on radiographic outcomes in the treatment of osteoporotic vertebral compression fractures (OVCF).MethodsA total of 98 patients undergoing non-operative treatment for recent single-level OVCF were reviewed retrospectively. Thirty-eight patients were treated by a once-daily subcutaneous injection of 20 micrograms of teriparatide (TPD group), whereas 60 patients received 35 mg of alendronate weekly (BP group). Except for these medications, the same treatment protocol was applied to both groups. The radiographic assessments included union status, vertebral kyphosis, and mid-vertebral body height. The rates of fracture site surgical intervention were also compared between the two groups. The mean follow-up period was 27 months (median 22.5, range 2 – 75 months).ResultsCox regression analysis showed that TPD reduced the time-to-union (adjusted relative hazard ratio: 1.86, 95% C.I.: 1.21 – 2.83). The union rate at six months after treatment was 89% in the TPD group and 68% in the BP group; the surgical intervention rate was significantly higher in the TPD group (p = 0.026, adjusted odds ratio: 8.15, 95% C.I.: 2.02 – 43.33). The change in local kyphosis was 4.6° in the TPD group and 3.8° in the BP group (p = 0.495, paired t-test). The change of mid-vertebral body height was 4.4 mm in the TPD group and 3.4 mm in the BP group (p = 0.228, paired t-test). Fracture site surgical interventions were not required in the TPD group; however, two patients in the BP group eventually underwent surgical treatment for symptomatic non-union or vertebral collapse.ConclusionsThis retrospective study suggests that teriparatide may enhance fracture healing and improve the union rate in OVCF.

【 授权许可】

CC BY   
© The Author(s). 2017