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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.


Kaplan-Meier curves for time-to-union in the TPD group versus the BP group. The Kaplan-Meier curve showed the time course of union in the TPD group and the BP group (p < 0.001, log-rank test). The thin black arrow shows the end of follow-up with non-union, and the bold white arrow indicates the end of follow-up due to surgical intervention. The union rate was 89% in the TPD group and 68% in the BP group by six months after treatment (p = 0.026, Fisher’s exact test). At the final follow-up, 97% of those in the TPD group and 90% of those in the BP group achieved a stable union (p = 0.243, Fisher’s exact test)
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Fig2: Kaplan-Meier curves for time-to-union in the TPD group versus the BP group. The Kaplan-Meier curve showed the time course of union in the TPD group and the BP group (p < 0.001, log-rank test). The thin black arrow shows the end of follow-up with non-union, and the bold white arrow indicates the end of follow-up due to surgical intervention. The union rate was 89% in the TPD group and 68% in the BP group by six months after treatment (p = 0.026, Fisher’s exact test). At the final follow-up, 97% of those in the TPD group and 90% of those in the BP group achieved a stable union (p = 0.243, Fisher’s exact test)

Mentions: Kaplan-Meier survival analysis showed a significant difference in the time-to-union between the two groups (p < 0.001, log-rank test) (Fig. 2). Cox regression analysis showed an adjusted relative hazard for TPD versus BP use of 1.86 (95% C.I.: 1.21–2.83). The radiographic union rate was 89% (34/38 patients) in the TPD group versus 68% (41/60 patients) in the BP group at six months after treatment, and the difference was significant (p = 0.026, Fisher’s exact test). At the final follow-up, 97% of patients (37/38 patients) in the TPD group and 90% of patients (54/60 patients) in the BP group achieved radiographic union (p = 0.243, Fisher’s exact test). Multiple logistic regression analyses were conducted using stepwise regression to adjust for heterogeneity (age, gender, fracture level, bone mineral density, pre-existing vertebral fracture, medication used, posterior wall fracture, and prior bisphosphonate use) between the two groups (Table 2). Regarding TPD versus BP use, the adjusted odds ratio for union at six months after treatment was 8.15 (95% C.I.: 2.02–43.33). Fracture site surgical interventions were not required in the TPD group, whereas two patients in the BP group eventually underwent surgical treatment. One patient was treated by balloon kyphoplasty for symptomatic non-union, and the other underwent posterior decompression and fusion for vertebral collapse with a neurological deficit.Fig. 2


Effect of teriparatide (rh-PTH 1 – 34) versus bisphosphonate on the healing of osteoporotic vertebral compression fracture: A retrospective comparative study
Kaplan-Meier curves for time-to-union in the TPD group versus the BP group. The Kaplan-Meier curve showed the time course of union in the TPD group and the BP group (p < 0.001, log-rank test). The thin black arrow shows the end of follow-up with non-union, and the bold white arrow indicates the end of follow-up due to surgical intervention. The union rate was 89% in the TPD group and 68% in the BP group by six months after treatment (p = 0.026, Fisher’s exact test). At the final follow-up, 97% of those in the TPD group and 90% of those in the BP group achieved a stable union (p = 0.243, Fisher’s exact test)
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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

Fig2: Kaplan-Meier curves for time-to-union in the TPD group versus the BP group. The Kaplan-Meier curve showed the time course of union in the TPD group and the BP group (p < 0.001, log-rank test). The thin black arrow shows the end of follow-up with non-union, and the bold white arrow indicates the end of follow-up due to surgical intervention. The union rate was 89% in the TPD group and 68% in the BP group by six months after treatment (p = 0.026, Fisher’s exact test). At the final follow-up, 97% of those in the TPD group and 90% of those in the BP group achieved a stable union (p = 0.243, Fisher’s exact test)
Mentions: Kaplan-Meier survival analysis showed a significant difference in the time-to-union between the two groups (p < 0.001, log-rank test) (Fig. 2). Cox regression analysis showed an adjusted relative hazard for TPD versus BP use of 1.86 (95% C.I.: 1.21–2.83). The radiographic union rate was 89% (34/38 patients) in the TPD group versus 68% (41/60 patients) in the BP group at six months after treatment, and the difference was significant (p = 0.026, Fisher’s exact test). At the final follow-up, 97% of patients (37/38 patients) in the TPD group and 90% of patients (54/60 patients) in the BP group achieved radiographic union (p = 0.243, Fisher’s exact test). Multiple logistic regression analyses were conducted using stepwise regression to adjust for heterogeneity (age, gender, fracture level, bone mineral density, pre-existing vertebral fracture, medication used, posterior wall fracture, and prior bisphosphonate use) between the two groups (Table 2). Regarding TPD versus BP use, the adjusted odds ratio for union at six months after treatment was 8.15 (95% C.I.: 2.02–43.33). Fracture site surgical interventions were not required in the TPD group, whereas two patients in the BP group eventually underwent surgical treatment. One patient was treated by balloon kyphoplasty for symptomatic non-union, and the other underwent posterior decompression and fusion for vertebral collapse with a neurological deficit.Fig. 2

View Article: PubMed Central - PubMed

ABSTRACT

Background: Teriparatide (recombinant human parathyroid hormone 1&ndash;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&nbsp;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&nbsp;months (median 22.5, range 2 &ndash; 75&nbsp;months).

Results: Cox regression analysis showed that TPD reduced the time-to-union (adjusted relative hazard ratio: 1.86, 95% C.I.: 1.21 &ndash; 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&thinsp;=&thinsp;0.026, adjusted odds ratio: 8.15, 95% C.I.: 2.02 &ndash; 43.33). The change in local kyphosis was 4.6&deg; in the TPD group and 3.8&deg; in the BP group (p&thinsp;=&thinsp;0.495, paired t-test). The change of mid-vertebral body height was 4.4&nbsp;mm in the TPD group and 3.4&nbsp;mm in the BP group (p&thinsp;=&thinsp;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.