title: Effect of teriparatide (rh-PTH 1-34) versus bisphosphonate on the healing of osteoporotic vertebral compression fracture: A retrospective comparative study.
abstract: 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).
  
  
  
  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).
  
  
  
  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.
  
  
  
  This retrospective study suggests that teriparatide may enhance fracture healing and improve the union rate in OVCF.
authors.affiliation: Spine Center, Hakodate Central General Hospital, Hon-cho 33-2, Hakodate, Hokkaido, 040-8585, Japan. iwataakira0126@yahoo.co.jp.|Department of Orthopaedic Surgery, Hokkaido University, N15 W7 Kita-ward, Sapporo, Hokkaido, 060-8638, Japan. iwataakira0126@yahoo.co.jp.
authors.forename: Akira
authors.identifier: 0000-0002-2376-8827
authors.initials: A
authors.lastname: Iwata
authors.affiliation: Spine Center, Hakodate Central General Hospital, Hon-cho 33-2, Hakodate, Hokkaido, 040-8585, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Kanayama
authors.affiliation: Spine Center, Hakodate Central General Hospital, Hon-cho 33-2, Hakodate, Hokkaido, 040-8585, Japan.
authors.forename: Fumihiro
authors.initials: F
authors.lastname: Oha
authors.affiliation: Spine Center, Hakodate Central General Hospital, Hon-cho 33-2, Hakodate, Hokkaido, 040-8585, Japan.
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Hashimoto
authors.affiliation: Department of Orthopaedic Surgery, Hokkaido University, N15 W7 Kita-ward, Sapporo, Hokkaido, 060-8638, Japan.
authors.forename: Norimasa
authors.initials: N
authors.lastname: Iwasaki
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019386:Alendronate / Q000494:pharmacology / Q000627:therapeutic use*; D050071:Bone Density Conservation Agents / Q000494:pharmacology / Q000627:therapeutic use*; D005260:Female; D017102:Fracture Healing / Q000187:drug effects; D050815:Fractures, Compression / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D058866:Osteoporotic Fractures / Q000188:drug therapy*; D012189:Retrospective Studies; D016103:Spinal Fractures / Q000188:drug therapy*; D019379:Teriparatide / Q000494:pharmacology / Q000627:therapeutic use*
chemical_list: D050071:Bone Density Conservation Agents; D019379:Teriparatide; D019386:Alendronate
keywords: Bisphosphonates; Osteoporosis; Osteoporotic vertebral compression fracture; Recombinant human parathyroid hormone 1–34; Teriparatide; Union rate