title: Prospective 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.
abstract: Most post-vertebroplasty new-onset adjacent vertebral compression fractures (VCFs) occur within 2-3 months, and antiresorptive agents do not significantly reduce the risk of their occurrence. In opposite mechanism, teriparatide directly stimulates bone formation and improves bone strength and quality faster. The therapeutic effect of teriparatide is better than that of vertebroplasty combined with an antiresorptive treatment and is a potentially useful therapy for new-onset adjacent VCFs after vertebroplasty.
  
  
  BACKGROUND
  Following vertebroplasty, patients are at increased risk of new-onset adjacent-level VCFs. The therapeutic effect of antiresorptive agents is too slow, and they are associated with the risk of new VCFs. Teriparatide markedly increases bone formation and strength and reduces the incidence of new-onset VCFs. This prospective cohort study compared the therapeutic effects of teriparatide with those of combined vertebroplasty and an anti-resorber for treating new-onset adjacent VCFs after vertebroplasty.
  
  
  METHODS
  Fifty patients with adjacent VCFs were randomly assigned to two groups: teriparatide only (group A) and additional vertebroplasty combined with an antiresorptive agent (group B). Relevant clinical data of the two groups were prospectively compared.
  
  
  RESULTS
  The 22 patients in group A were at higher risk of new VCFs than those in group B (22 patients); they were older and had more pre-existing fractures (p < 0.05). Patients treated with teriparatide had a significantly lower incidence of new-onset VCFs (odds ratio = 0.21; 95% confidence interval, 0.02-2.10). Teriparatide-mediated VCF reduction was 78.57%, which was markedly better than that of group B. The teriparatide group had a significant decrease in the visual analog scale and an increase in the Japanese Orthopedic Association low back pain score after 6 months of treatment (p < 0.05). The increase in lumbar spine BMD was marked in the teriparatide group (21.70% vs. 6.87%) after an 18-month treatment.
  
  
  CONCLUSIONS
  Treatment of post-vertebroplasty adjacent VCFs with teriparatide (no new vertebroplasty) was more effective than that of repeated vertebroplasties combined with an anti-resorber.
authors.affiliation: Department of Neurosurgery, Shuang Ho Hospital, Taipei Medical University, No 291, Jhongjheng Rd, Jhonghe, New Taipei City, 23561 Taiwan, Republic of China. britsey@gmail.com
authors.forename: Y-Y
authors.initials: YY
authors.lastname: Tseng
authors.forename: C-H
authors.initials: CH
authors.lastname: Su
authors.forename: T-N
authors.initials: TN
authors.lastname: Lui
authors.forename: Y-S
authors.initials: YS
authors.lastname: Yeh
authors.forename: S-H
authors.initials: SH
authors.lastname: Yeh
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019386:Alendronate / Q000627:therapeutic use; D015519:Bone Density / Q000187:drug effects; D050071:Bone Density Conservation Agents / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D005260:Female; D050815:Fractures, Compression / Q000188:drug therapy* / Q000209:etiology / Q000601:surgery; D006801:Humans; D017116:Low Back Pain / Q000209:etiology / Q000517:prevention & control; D008159:Lumbar Vertebrae / Q000503:physiopathology; D008297:Male; D058866:Osteoporotic Fractures / Q000188:drug therapy / Q000209:etiology / Q000601:surgery; D010147:Pain Measurement / Q000379:methods; D011446:Prospective Studies; D012086:Reoperation; D055502:Secondary Prevention; D016103:Spinal Fractures / Q000188:drug therapy* / Q000209:etiology / Q000601:surgery; D019379:Teriparatide / Q000627:therapeutic use*; D016896:Treatment Outcome; D054854:Vertebroplasty / Q000009:adverse effects* / Q000379:methods
chemical_list: D050071:Bone Density Conservation Agents; D019379:Teriparatide; D019386:Alendronate