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

View Article: PubMed Central - PubMed

ABSTRACT

Background: Teriparatide (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).

Methods: A 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).

Results: Cox 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.

Conclusions: This retrospective study suggests that teriparatide may enhance fracture healing and improve the union rate in OVCF.

No MeSH data available.


Related in: MedlinePlus

Bridging bone around a vertebral cleft. Although a vertebral cleft was observed, the presence of bony bridging around the fractured vertebra (arrows) was interpreted as diagnostic of radiographic union
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Fig1: Bridging bone around a vertebral cleft. Although a vertebral cleft was observed, the presence of bony bridging around the fractured vertebra (arrows) was interpreted as diagnostic of radiographic union

Mentions: Union status and deformity of the fractured vertebra were assessed radiographically. Radiographic examinations were performed once a week during the first month of treatment, once a month until the third month, and once every three months subsequently until union was confirmed. Assessment at six months after treatment was based on the radiographs obtained at six months plus/minus one month. The parameters included union rate at six months and at the final follow-up after treatment, vertebral kyphosis and mid-vertebral body height. Three independent observers assessed radiographic union (two examiners performed the evaluations independently, and another examiner independently assessed the cases when the conclusions of the two observers differed). Non-union was diagnosed by the presence of a vertebral cleft or abnormal motion at the fractured vertebra on the flexion-extension radiographs. Notwithstanding evidence of a vertebral cleft, the presence of trabecular continuity or bridging of bone around the cleft were regarded as radiographic union (Fig. 1). The Kappa statistic of intraclass correlation coefficient was 0.787 (95% confidence interval: 0.674 – 0.901). The Kappa statistic of inter-rater reliability was 0.952 (95% confidence interval: 0.887 – 1.000). The rate of fracture site surgical intervention was also compared between the two groups.Fig. 1


Effect of teriparatide (rh-PTH 1 – 34) versus bisphosphonate on the healing of osteoporotic vertebral compression fracture: A retrospective comparative study
Bridging bone around a vertebral cleft. Although a vertebral cleft was observed, the presence of bony bridging around the fractured vertebra (arrows) was interpreted as diagnostic of radiographic union
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC5384154&req=5

Fig1: Bridging bone around a vertebral cleft. Although a vertebral cleft was observed, the presence of bony bridging around the fractured vertebra (arrows) was interpreted as diagnostic of radiographic union
Mentions: Union status and deformity of the fractured vertebra were assessed radiographically. Radiographic examinations were performed once a week during the first month of treatment, once a month until the third month, and once every three months subsequently until union was confirmed. Assessment at six months after treatment was based on the radiographs obtained at six months plus/minus one month. The parameters included union rate at six months and at the final follow-up after treatment, vertebral kyphosis and mid-vertebral body height. Three independent observers assessed radiographic union (two examiners performed the evaluations independently, and another examiner independently assessed the cases when the conclusions of the two observers differed). Non-union was diagnosed by the presence of a vertebral cleft or abnormal motion at the fractured vertebra on the flexion-extension radiographs. Notwithstanding evidence of a vertebral cleft, the presence of trabecular continuity or bridging of bone around the cleft were regarded as radiographic union (Fig. 1). The Kappa statistic of intraclass correlation coefficient was 0.787 (95% confidence interval: 0.674 – 0.901). The Kappa statistic of inter-rater reliability was 0.952 (95% confidence interval: 0.887 – 1.000). The rate of fracture site surgical intervention was also compared between the two groups.Fig. 1

View Article: PubMed Central - PubMed

ABSTRACT

Background: Teriparatide (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).

Methods: A 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).

Results: Cox 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.

Conclusions: This retrospective study suggests that teriparatide may enhance fracture healing and improve the union rate in OVCF.

No MeSH data available.


Related in: MedlinePlus