Teriparatide improves volumetric bone mineral density and fine bone structure in the UIV+1 vertebra, and reduces bone failure type PJK after surgery for adult spinal deformity

• Published in: Osteoporosis international 2016-12, Vol.27 (12), p.3495-3502
• Main Authors: Yagi, M., Ohne, H., Konomi, T., Fujiyoshi, K., Kaneko, S., Komiyama, T., Takemitsu, M., Yato, Y., Machida, M., Asazuma, T.
• Format: Article
• Language: English
• Subjects: Aged; Bone density; Bone Density - drug effects; Bone mineral content; Bone mineral density; Bone strength; Bone surgery; Cancellous bone; Dual energy X-ray absorptiometry; Endocrinology; Female; Hip; Humans; Kyphosis; Medicine; Medicine & Public Health; Middle Aged; Original Article; Orthopedics; Osteoporosis; Parathyroid hormone; Prospective Studies; Reconstructive surgery; Rheumatology; Spine; Spine - abnormalities; Spine - drug effects; Spine - surgery; Surgery; Teriparatide - therapeutic use; Treatment Outcome; Vertebrae
• ISSN: 0937-941X; 1433-2965
• DOI: 10.1007/s00198-016-3676-6

Summary We conducted a prospective comparative study of the effect of teriparatide therapy for preventing vertebral-failure-type PJK after reconstructive surgery for adult spinal deformity. Prophylactic teriparatide improved the volumetric bone mineral density and fine bone structure of the vertebra above the upper-instrumented vertebra and reduced the incidence of vertebral-failure-type PJK. Introduction Proximal junctional kyphosis (PJK) is a complication after corrective surgery for spinal deformity. This study sought to determine whether teriparatide (TP) is an effective prophylactic against PJK type 2 (vertebral fracture) in surgically treated patients with adult spinal deformity (ASD). Methods Forty-three patients who started TP therapy immediately after surgery and 33 patients who did not receive TP were enrolled in this prospective case series. These patients were female, over 50, surgically treated for ASD, and followed for at least 2 years. Preoperative and postoperative standing whole-spine X-rays and dual-energy X-ray absorptiometry scans, and multidetector CT images obtained before and 6 months after surgery were used to analyze the bone strength in the vertebra above the upper-instrumented vertebra (UIV+1). Results Mean age was 67.9 years. After 6 months of treatment, mean hip-bone mineral density (BMD) increased from 0.721 to 0.771 g/cm 2 in the TP group and decreased from 0.759 to 0.729 g/cm 2 in the control group. This percent BMD change between groups was significant ( p