J Korean Neurosurg Soc.  2020 Nov;63(6):794-805. 10.3340/jkns.2020.0110.

Therapeutic Effect of Teriparatide for Osteoporotic Thoracolumbar Burst Fracture in Elderly Female Patients

• Yu D
• Kim S
• Jeon I

• KMID: 2508610
• DOI: http://doi.org/10.3340/jkns.2020.0110

Abstract

Objective
: Teriparatide is known as an effective anabolic agent not only for severe osteoporosis but also for bone healing and union. We explored the possibility of teriparatide as an alternative treatment option for osteoporotic thoracolumbar (TL) burst fracture.
Methods
: This retrospective study enrolled 35 female patients with mean age of 73.77±6.71 years (61–88) diagnosed as osteoporotic TL burst fracture with ≥4 of thoracolumbar injury classification and severity (TLICS) score and no neurological deficits. All patients were treated by teriparatide only (12 of group A), teriparatide plus vertebroplasty (12 of group B), or surgical fixation with fusion (11 of group C), and followed up for 12 months. Radiological outcomes were evaluated using radiological parameters including kyphotic angle (KA), segmental vertebral kyphotic angle (SVKA), compression ratio (CR), and vertebral body height (anterior [AH], middle [MH], posterior [PH]). Functional outcomes were evaluated using visual analog scale (VAS) and Macnab classification (MC).
Results
: There were no statistical significant differences in age, bone mineral density (-3.36±0.73), and TLICS score (4.34±0.48) among the three groups (p>0.05). Teriparatide was administered during 8.63±2.32 months in group A and B. In 12-month radiological outcomes, there were significant restoration in SVKA, CR, AH, and MH of group B and KA, SVKA, CR, AH, and MH of group C compared to group A with no radiological changes (p<0.05). All groups showed similar significant improvements in 12-month functional outcomes, although group B and C showed a better 1-month VAS, 1-month MC, 3-month MC compared to group A (p<0.05).
Conclusion
: Non-surgical treatment with teriparatide showed similar 12-month functional outcomes compared to surgical fixation with fusion. The additional vertebroplasty to teriparatide and surgical fixation with fusion were more helpful to improve short-term functional outcomes with structural restoration compared to teriparatide only.

Keyword

Teriparatide; Spine; Fracture; Osteoporosis; Aged

Figure

• 

  Fig. 1. Measurement of radiological parameters on sagittal plain X-ray. Kyphotic angle (KA) is the angle between the upper endplate of the vertebra above the fractured vertebra and the lower endplate of the vertebra under the fractured vertebra. Segmental vertebral kyphotic angle (SVKA) is the angle between the upper and lower endplate of fractured vertebra, compression ratio (CR) is the percentage of anterior vertebra body compression with respect to the average height of anterior vertebra bodies just above and below to the fractured vertebra (1 - [2AH / a + b] × 100%). Vertebral body height was measured at the anterior (AH), middle (MH), posterior (PH) borders.

• 

  Fig. 2. A 70-year-old female patient with a L1 burst fracture (thoracolumbar injury classification and severity score 5 and McCormack’s load sharing score 7) was treated conservatively using teriparatide because of severe chronic obstructive pulmonary disease. Sagittal (A) and axial (B) view of computed tomography at baseline shows L1 burst fracture with ≥50% of compression ratio and posterior column involvement. Lateral plain X-ray at 12-month (D) shows similar radiological features compared to baseline (C).

• 

  Fig. 3. A 78-year-old female patient with a L1 burst fracture (thoracolumbar injury classification and severity score 4 and McCormack’s load sharing score 7) was treated conservatively using teriparatide with vertebroplasty because of congestive heart failure and old age. Sagittal (A) and axial (B) view of computed tomography at baseline shows L1 burst fracture with ≥70% of compression ratio and retropulsed bony fragment. Lateral plain X-ray at 12-month (D) shows similar kyphotic angle and restored segmental vertebral kyphotic angle with re-expanded vertebral body after cement filling compared to baseline (C).

• 

  Fig. 4. A 71-year-old female patient with a L1 burst fracture (thoracolumbar injury classification and severity score 5 and McCormack’s load sharing score 7) was treated surgically with screw fixation and posterior fusion. Sagittal (A) and axial (B) view of computed tomography at baseline shows L1 burst fracture with ≥50% of compression ratio and retropulsed bony fragment. Lateral plain X-ray at 12-month (D) shows restored kyphotic, segmental vertebral kyphotic angle, and vertebral heights with bone fusion compared to baseline (C).

Reference

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