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Teriparatide Accelerates Lumbar Posterolateral Fusion in Women With Postmenopausal Osteoporosis: Prospective Study

Ohtori, Seiji, MD, PhD; Inoue, Gen, MD, PhD; Orita, Sumihisa, MD, PhD; Yamauchi, Kazuyo, MD, PhD; Eguchi, Yawara, MD, PhD; Ochiai, Nobuyasu, MD, PhD; Kishida, Shunji, MD, PhD; Kuniyoshi, Kazuki, MD, PhD; Aoki, Yasuchika, MD, PhD; Nakamura, Junichi, MD, PhD; Ishikawa, Tetsuhiro, MD, PhD; Miyagi, Masayuki, MD, PhD; Kamoda, Hiroto, MD, PhD; Suzuki, Miyako, MD; Kubota, Gou, MD; Sakuma, Yoshihiro, MD; Oikawa, Yasuhiro, MD; Inage, Kazuhide, MD; Sainoh, Takeshi, MD; Takaso, Masashi, MD, PhD; Ozawa, Tomoyuki, MD, PhD; Takahashi, Kazuhisa, MD, PhD; Toyone, Tomoaki, MD, PhD

doi: 10.1097/BRS.0b013e31826ca2a8

Study Design. Prospective trial.

Objective. To examine the clinical efficacy of teriparatide for bone union after instrumented lumbar posterolateral fusion using local bone grafting in women with postmenopausal osteoporosis.

Summary of Background Data. Intermittent parathyroid hormone (PTH) treatment increases bone mass and reduces the risk for osteoporotic vertebral fractures. Recombinant human PTH (1–34) has already been approved as a treatment for severe osteoporosis. Preclinical data support the efficacy of PTH for lumbar spinal fusion. However, clinical results of PTH for spinal fusion have not yet been reported.

Methods. Fifty-seven women with osteoporosis diagnosed with degenerative spondylolisthesis were divided into 2 treatment groups, a teriparatide group (n = 29; daily subcutaneous injection of 20 μg of teriparatide) and a bisphosphonate group (n = 28; weekly oral administration of 17.5 mg of risedronate). All patients underwent decompression and 1- or 2-level instrumented posterolateral fusion with a local bone graft. Fusion rate, duration of bone union, and pain scores were evaluated 1 year after surgery.

Results. Pain scores improved after surgery; however, no significant difference was noted between the groups after surgery. The rate of bone union was 82% in the teriparatide group and 68% in the bisphosphonate group. Average duration of bone union was 8 months in the teriparatide group and 10 months in the bisphosphonate group. The rate of bone union and average of duration of bone union in the teriparatide group patients were significantly superior to those in the bisphosphonate group.

Conclusion. Daily subcutaneous injection of teriparatide for bone union using local bone grafting after instrumented lumbar posterolateral fusion in women with postmenopausal osteoporosis was more effective than oral administration of bisphosphonate.

57 osteoporotic postmenopausal women with degenerative spondylolisthesis underwent instrumented posterolateral fusion surgery with 10-month daily subcutaneous injection of teriparatide. This teriparatide treatment significantly improved bone union after surgery compared with oral administration of bisphosphonate.

From the Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan

Address correspondence and reprint requests to Seiji Ohtori, MD, PhD, Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1–8-1 Inohana, Chuo-ku, Chiba 260–8670, Japan; E-mail:

Acknowledgment date: April 30, 2012. Revision date: July 24, 2012. Acceptance date: July 28, 2012.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work.

No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

© 2012 Lippincott Williams & Wilkins, Inc.