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Comparison of Teriparatide and Bisphosphonate Treatment to Reduce Pedicle Screw Loosening After Lumbar Spinal Fusion Surgery in Postmenopausal Women With Osteoporosis From a Bone Quality Perspective

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, PhD; Kubota, Gou MD; Sakuma, Yoshihiro MD; Oikawa, Yasuhiro MD; Inage, Kazuhide MD; Sainoh, Takeshi MD; Takaso, Masashi MD, PhD; Toyone, Tomoaki MD, PhD; Takahashi, Kazuhisa MD, PhD

doi: 10.1097/BRS.0b013e31828826dd

Study Design. Prospective study.

Objective. To examine the efficacy of teriparatide or bisphosphonate treatment to reduce pedicle screw (PS) loosening after instrumented lumbar posterolateral fusion in postmenopausal women with osteoporosis.

Summary of Background Data. Failure of fixation caused by loosening of PSs in osteoporosis is a problem in spinal surgery. Oral administration of bisphosphonate or intermittent injection of parathyroid hormone treatment increases bone mass and reduces the risk of osteoporotic vertebral fractures. Although these treatments may be factor in improving bone quality, a clinical study of the efficacy of bisphosphonate or parathyroid hormone for reducing PS loosening that addresses the quality of the bone marrow and pedicle cortex has not yet been reported.

Methods. Sixty-two women with osteoporosis diagnosed with degenerative spondylolisthesis were divided into 3 groups: a teriparatide group (daily subcutaneous injection of 20 μg of teriparatide, n = 20), a bisphosphonate group (daily oral administration 2.5 mg of risedronate, n = 20), and a control group (without medication for osteoporosis, n = 22). All patients underwent decompression and 1- or 2-level instrumented posterolateral fusion with a local bone graft. Loosening of PSs and surgical outcome were evaluated radiographically, clinically, and by computed tomography 12 months after surgery.

Results. At 12-month follow-up, the incidence of PS loosening was 7% to 13% in the teriparatide group, 13% to 26% in the risedronate group, and 15% to 25% in the control group. The incidence of PS loosening in the teriparatide group was significantly lower than that in the risedronate or the control group (P < 0.05). In contrast, the extent of PS loosening in the risedronate group was not significantly different from that in the control group (P > 0.05).

Conclusion. Our findings suggest that administration of teriparatide increased the quality of the lumbar spine bone marrow and pedicle cortex.

Level of Evidence: 3

Sixty-two osteoporotic postmenopausal women with degenerative spondylolisthesis underwent instrumented posterolateral fusion surgery. Daily subcutaneous injection of t eriparatide significantly reduced the incidence of pedicle screw loosening after surgery compared with that in bisphosphonatetreated women and women treated without medication for osteoporosis.

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: August 28, 2012. First revision date: December 8, 2012. Acceptance date: January 10, 2013.

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

No funds were received in support of this work.

No relevant financial activities outside the submitted work.

© 2013 Lippincott Williams & Wilkins, Inc.