Korean J Neurotrauma.  2019 Apr;15(1):19-27. 10.13004/kjnt.2019.15.e13.

Can Three Months of Teriparatide Be One of Treatment Options for Osteoporotic Vertebral Compression Fracture Patients?

• Kang JH
• Yang SM
• Im SB
• Jeong JH

• KMID: 2444201
• DOI: http://doi.org/10.13004/kjnt.2019.15.e13

Abstract

OBJECTIVE
Osteoporosis is one of the most common causes of vertebral compression fractures (VCFs). Teriparatide, a recombinant human parathyroid hormone, is the first anabolic agent for the treatment of osteoporosis. The aim of this study was to determine whether 3 months of teriparatide could be effective for patients with osteoporotic VCF at the thoracolumbar spine.
METHODS
We reviewed 25 patients with thoracolumbar osteoporotic compression fractures between July 2012 and October 2016 who could be followed up for more than 1 year. Patients were divided into 2 groups depending on the use of teriparatide: 14 patients received teriparatide through subcutaneous injection (group I) and 11 patients did not receive teriparatide (group II). Demographic data, bone mineral density, hospitalization period, changes in the visual analogue scale (VAS) score, body mass index, and medical history such as smoking, alcohol, diabetes, and steroid usage were reviewed. Radiographs were also reviewed to evaluate vertebral body compression percentages and kyphotic angles.
RESULTS
Overall changes of VAS score between injury and follow-up were statistically improved in both groups at 2 to 3 weeks post-injury. However, difference in VAS improvement at a specific time between the 2 groups was not statistically significant. Overall kyphotic angle and compression percentage between injury and follow-up time were increased in group II than those in group I, although the difference between the 2 groups was not statistically significant.
CONCLUSION
Three-month of teriparatide did not show protective effects on progression of fractured vertebral body collapse or kyphotic changes in patients with osteoporosis.

Keyword

Fractures, compression; Osteoporotic fractures; Teriparatide; Thoracic vertebrae; Treatment outcome

MeSH Terms

Body Mass Index
Bone Density
Follow-Up Studies
Fractures, Compression*
Hospitalization
Humans
Injections, Subcutaneous
Osteoporosis
Osteoporotic Fractures
Parathyroid Hormone
Smoke
Smoking
Spine
Teriparatide*
Thoracic Vertebrae
Treatment Outcome
Parathyroid Hormone
Smoke
Teriparatide

Figure

• 

  FIGURE 1 Measured factors. (A) Vertebral body compression percentage was calculated as the percentage of anterior vertebral body compression with respect to the average height of anterior vertebral bodies immediately cephalad and caudad to the injury level (formula: V2/[V1+V3]/2×100%) (B) Vertebral wedge angle (kyphotic angle). The angle between the superior endplate of the vertebral body above and the inferior endplate of the vertebral body below the fractured vertebra on the lateral radiograph.

• 

  FIGURE 2 Changes of VAS. Group I: patients received teriparatide by injection, group II: patients did not receive teriparatide.VAS: visual analogue scale.*p<0.05.

• 

  FIGURE 3 Changes of compression percentage. Group I: patients received teriparatide by injection, group II: patients did not receive teriparatide.

• 

  FIGURE 4 Changes of kyphotic angle. Group I: patients received teriparatide by injection, group II: patients did not receive teriparatide.

Reference

1. Alvarez L, Alcaraz M, Pérez-Higueras A, Granizo JJ, de Miguel I, Rossi RE, et al. Percutaneous vertebroplasty: functional improvement in patients with osteoporotic compression fractures. Spine (Phila Pa 1976). 2006; 31:1113–1118. PMID: 16648745.

2. Anderson PA, Froyshteter AB, Tontz WL Jr. Meta-analysis of vertebral augmentation compared with conservative treatment for osteoporotic spinal fractures. J Bone Miner Res. 2013; 28:372–382. PMID: 22991246.

3. Aspenberg P, Genant HK, Johansson T, Nino AJ, See K, Krohn K, et al. Teriparatide for acceleration of fracture repair in humans: a prospective, randomized, double-blind study of 102 postmenopausal women with distal radial fractures. J Bone Miner Res. 2010; 25:404–414. PMID: 19594305.

4. Black DM, Cummings SR, Karpf DB, Cauley JA, Thompson DE, Nevitt MC, et al. Randomised trial of effect of alendronate on risk of fracture in women with existing vertebral fractures. Fracture Intervention Trial Research Group. Lancet. 1996; 348:1535–1541. PMID: 8950879.

5. Body JJ, Gaich GA, Scheele WH, Kulkarni PM, Miller PD, Peretz A, et al. A randomized double-blind trial to compare the efficacy of teriparatide [recombinant human parathyroid hormone (1-34)] with alendronate in postmenopausal women with osteoporosis. J Clin Endocrinol Metab. 2002; 87:4528–4535. PMID: 12364430.

6. Dempster DW, Cosman F, Parisien M, Shen V, Lindsay R. Anabolic actions of parathyroid hormone on bone. Endocr Rev. 1993; 14:690–709. PMID: 8119233.

7. Diamond TH, Champion B, Clark WA. Management of acute osteoporotic vertebral fractures: a nonrandomized trial comparing percutaneous vertebroplasty with conservative therapy. Am J Med. 2003; 114:257–265. PMID: 12681451.

8. Dobnig H, Turner RT. Evidence that intermittent treatment with parathyroid hormone increases bone formation in adult rats by activation of bone lining cells. Endocrinology. 1995; 136:3632–3638. PMID: 7628403.

9. Evans AJ, Jensen ME, Kip KE, DeNardo AJ, Lawler GJ, Negin GA, et al. Vertebral compression fractures: pain reduction and improvement in functional mobility after percutaneous polymethylmethacrylate vertebroplasty retrospective report of 245 cases. Radiology. 2003; 226:366–372. PMID: 12563127.

10. Goldhahn J, Féron JM, Kanis J, Papapoulos S, Reginster JY, Rizzoli R, et al. Implications for fracture healing of current and new osteoporosis treatments: an ESCEO consensus paper. Calcif Tissue Int. 2012; 90:343–353. PMID: 22451221.

11. Hasserius R, Karlsson MK, Nilsson BE, Redlund-Johnell I, Johnell O. European Vertebral Osteoporosis Study. Prevalent vertebral deformities predict increased mortality and increased fracture rate in both men and women: a 10-year population-based study of 598 individuals from the Swedish cohort in the European Vertebral Osteoporosis Study. Osteoporos Int. 2003; 14:61–68. PMID: 12577186.

12. Hasserius R, Karlsson MK, Jónsson B, Redlund-Johnell I, Johnell O. Long-term morbidity and mortality after a clinically diagnosed vertebral fracture in the elderly--a 12- and 22-year follow-up of 257 patients. Calcif Tissue Int. 2005; 76:235–242. PMID: 15812579.

13. Itshayek E, Miller P, Barzilay Y, Hasharoni A, Kaplan L, Fraifeld S, et al. Vertebral augmentation in the treatment of vertebral compression fractures: review and new insights from recent studies. J Clin Neurosci. 2012; 19:786–791. PMID: 22595547.

14. Iwata A, Kanayama M, Oha F, Hashimoto T, Iwasaki N. Effect of teriparatide (rh-PTH 1-34) versus bisphosphonate on the healing of osteoporotic vertebral compression fracture: A retrospective comparative study. BMC Musculoskelet Disord. 2017; 18:148. PMID: 28388910.

15. Jilka RL, Weinstein RS, Bellido T, Roberson P, Parfitt AM, Manolagas SC. Increased bone formation by prevention of osteoblast apoptosis with parathyroid hormone. J Clin Invest. 1999; 104:439–446. PMID: 10449436.

16. Kakar S, Einhorn TA, Vora S, Miara LJ, Hon G, Wigner NA, et al. Enhanced chondrogenesis and Wnt signaling in PTH-treated fractures. J Bone Miner Res. 2007; 22:1903–1912. PMID: 17680724.

17. Kaufman JM, Orwoll E, Goemaere S, San Martin J, Hossain A, Dalsky GP, et al. Teriparatide effects on vertebral fractures and bone mineral density in men with osteoporosis: treatment and discontinuation of therapy. Osteoporos Int. 2005; 16:510–516. PMID: 15322742.

18. Krege JH, Wan X. Teriparatide and the risk of nonvertebral fractures in women with postmenopausal osteoporosis. Bone. 2012; 50:161–164. PMID: 22036910.

19. Lee HM, Park SY, Lee SH, Suh SW, Hong JY. Comparative analysis of clinical outcomes in patients with osteoporotic vertebral compression fractures (OVCFs): conservative treatment versus balloon kyphoplasty. Spine J. 2012; 12:998–1005. PMID: 23026068.

20. Nakazawa T, Nakajima A, Shiomi K, Moriya H, Einhorn TA, Yamazaki M. Effects of low-dose, intermittent treatment with recombinant human parathyroid hormone (1-34) on chondrogenesis in a model of experimental fracture healing. Bone. 2005; 37:711–719. PMID: 16143574.

21. Neer RM, Arnaud CD, Zanchetta JR, Prince R, Gaich GA, Reginster JY, et al. Effect of parathyroid hormone (1-34) on fractures and bone mineral density in postmenopausal women with osteoporosis. N Engl J Med. 2001; 344:1434–1441. PMID: 11346808.

22. Ohtori S, Akazawa T, Murata Y, Kinoshita T, Yamashita M, Nakagawa K, et al. Risedronate decreases bone resorption and improves low back pain in postmenopausal osteoporosis patients without vertebral fractures. J Clin Neurosci. 2010; 17:209–213. PMID: 20044258.

23. Ohtori S, Inoue G, Orita S, Yamauchi K, Eguchi Y, Ochiai N, et al. Comparison of teriparatide and bisphosphonate treatment to reduce pedicle screw loosening after lumbar spinal fusion surgery in postmenopausal women with osteoporosis from a bone quality perspective. Spine (Phila Pa 1976). 2013; 38:E487–E492. PMID: 23354115.

24. Orita S, Ohtori S, Koshi T, Yamashita M, Yamauchi K, Inoue G, et al. The effects of risedronate and exercise on osteoporotic lumbar rat vertebrae and their sensory innervation. Spine (Phila Pa 1976). 2010; 35:1974–1982. PMID: 20959778.

25. Papaioannou A, Watts NB, Kendler DL, Yuen CK, Adachi JD, Ferko N. Diagnosis and management of vertebral fractures in elderly adults. Am J Med. 2002; 113:220–228. PMID: 12208381.

26. Park JH, Kang KC, Shin DE, Koh YG, Son JS, Kim BH. Preventive effects of conservative treatment with short-term teriparatide on the progression of vertebral body collapse after osteoporotic vertebral compression fracture. Osteoporos Int. 2014; 25:613–618. PMID: 23943161.

27. Peichl P, Holzer LA, Maier R, Holzer G. Parathyroid hormone 1-84 accelerates fracture-healing in pubic bones of elderly osteoporotic women. J Bone Joint Surg Am. 2011; 93:1583–1587. PMID: 21915572.

28. Ploeg WT, Veldhuizen AG, The B, Sietsma MS. Percutaneous vertebroplasty as a treatment for osteoporotic vertebral compression fractures: a systematic review. Eur Spine J. 2006; 15:1749–1758. PMID: 16823557.

29. Shi MM, Cai XZ, Lin T, Wang W, Yan SG. Is there really no benefit of vertebroplasty for osteoporotic vertebral fractures? A meta-analysis. Clin Orthop Relat Res. 2012; 470:2785–2799. PMID: 22729693.

30. Su CH, Tu PH, Yang TC, Tseng YY. Comparison of the therapeutic effect of teriparatide with that of combined vertebroplasty with antiresorptive agents for the treatment of new-onset adjacent vertebral compression fracture after percutaneous vertebroplasty. J Spinal Disord Tech. 2013; 26:200–206. PMID: 22134732.

31. Tsuchie H, Miyakoshi N, Kasukawa Y, Aonuma H, Shimada Y. Intermittent administration of human parathyroid hormone before osteosynthesis stimulates cancellous bone union in ovariectomized rats. Tohoku J Exp Med. 2013; 229:19–28. PMID: 23221107.

32. Tsuchie H, Miyakoshi N, Kasukawa Y, Nishi T, Abe H, Segawa T, et al. The effect of teriparatide to alleviate pain and to prevent vertebral collapse after fresh osteoporotic vertebral fracture. J Bone Miner Metab. 2016; 34:86–91. PMID: 25773046.

33. Tu PH, Liu ZH, Lee ST, Chen JF. Treatment of repeated and multiple new-onset osteoporotic vertebral compression fractures with teriparatide. J Clin Neurosci. 2012; 19:532–535. PMID: 22341147.

34. Wu CC, Wei JC, Hsieh CP, Yu CT. Enhanced healing of sacral and pubic insufficiency fractures by teriparatide. J Rheumatol. 2012; 39:1306–1307. PMID: 22661426.

35. Zhang D, Potty A, Vyas P, Lane J. The role of recombinant PTH in human fracture healing: a systematic review. J Orthop Trauma. 2014; 28:57–62. PMID: 23454854.