J Korean Orthop Assoc.  2019 Dec;54(6):528-536. 10.4055/jkoa.2019.54.6.528.

Treatment Effect with Weekly Teriparatide in the Vertebral Compression Fractures in Patients with Severe Osteoporosis

• Hwang SH
• Woo YK
• Jeon HS
• Suh SP
• Kim JY
• Kim JN

• KMID: 2469884
• DOI: http://doi.org/10.4055/jkoa.2019.54.6.528

Abstract

PURPOSE
This study examined the effects of a weekly teriparatide on the change in vertebral compression ratio, back pain, and vertebral fracture healing in osteoporosis patients with vertebral compression fractured induced by low energy trauma.
MATERIALS AND METHODS
From January 2016 to December 2017, 57 patients with severe osteoporotic vertebral fractures with a T score of −3.5 or less were included in this study. The changes in the vertebral compression ratio, visual analogue scale (VAS), Oswestry disability index (ODI) for at least 6 months were examined. The morphology of bone marrow edema and the presence of intervertebral cleft, osteocalcin, and N-terminal telopeptide (NTx) were also investigated.
RESULTS
The mean compression ratio was 20% in the experimental group (teripratide group) at 3 months, and 38% in the control group. A significant difference in the compression ratio of the vertebral body over time was observed (p < 0.05; t-test). A comparison of the compression ratio of the vertebral body with the follow-up duration in each group showed no significant increase in the, compression (p=0.063) in the experimental group and a significant increase in the control group (p < 0.05). The mean time to reach the plateau of the compression rate was one month in the experimental group and three months in the control group. The VAS score in the experimental and control group was 0.39 and 1.07 points, respectively. The ODI score in the experimental and control group was 33.72 and 39.52, respectively. At the last follow-up radiographs, there were no cases with an intervertebral cleft (0%) in the experimental group and 1 case (2.2%) in the control group. A significant difference in the osteocalcin level was observed between the injury and 6 months after the injury (p=0.003). In addition, there was no significant difference in the NTx level between the injury and 6 months after injury (p=0.960).
CONCLUSION
In vertebral compression fractures patients with severe osteoporosis, a weekly teriparatide can promote the union of fractures, prevent further collapse of the vertebral body, and reduce the back pain faster.

Keyword

osteoporosis; compression fracture; teriparatide

MeSH Terms

Back Pain
Bone Marrow
Edema
Follow-Up Studies
Fracture Healing
Fractures, Compression*
Humans
Osteocalcin
Osteoporosis*
Teriparatide*
Osteocalcin
Teriparatide

Figure

• 

  Figure 1 Measurement methods for the compression rate on simple X-ray. Compression rate=(m-b)/m×100. a, anterior vertebral height of upper vertebra; b, anterior vertebral height at the fracture level; c, anterior vertebral height of lower vertebra; m, mean value of a and c.

• 

  Figure 2 (A) Change in back pain visual analogue scale (VAS) in patients with osteoporotic compression vertebral fractures. (B) Change in the Oswestry disability index (ODI) scale.

• 

  Figure 3 Time to bone union was 1 month in the experimental group and 3 months in the control group.

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