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Abstract
Purpose
The research aimed to compare the therapeutic effect of teriparatide (TPTD) and zoledronic acid (ZOL) therapy on bone formation and spinal fusion in patients with osteoporosis (OP) who underwent transforaminal lumbar interbody fusion (TLIF).
Methods
On the basis of different anti-OP treatment options, the TPTD group was treated daily with TPTD (20 μg. ih. qd) for at least 6 months, while the ZOL group was treated with a single dose of ZOL (5 mg. ivgtt. st) postoperatively. The visual analogue scale (VAS), Oswestry Disability Index (ODI), bone mineral density (BMD), and concentration of bone turnover markers before, 6, and 12 months after surgery were evaluated. X-ray and three-dimensional computed tomography scans were performed at 6 and 12 months postoperatively to assess interbody fusion.
Results
The number of patients in the TPTD and ZOL groups was 29 and 38 patients, respectively. The VAS and ODI scores in both groups were significantly reduced at 6 and 12 months after TLIF. Compared with that of baseline, the lumbar spine BMD of TPTD patients increased significantly from 0.716±0.137 g/cm2 to 0.745±0.124 g/cm2 and 0.795±0.123 g/cm2 at 6 and 12 months, respectively, and was significantly higher than that of the ZOL group at 12 months (0.720±0.128 g/cm2). The bone formation marker, P1NP, in the TPTD group increased significantly (145.48±66.64 ng/mL and 119.55±88.27 ng/mL) compared with baseline (44.67±25.15 ng/mL) and in the ZOL group (28.82±19.76 ng/mL and 29.94±20.67 ng/mL) at 6 and 12 months, respectively. The fusion rates in the TPTD and ZOL groups were 57% and 45% at 6 months, without statistical significance. However, TPTD had a more statistically significant positive influence on fusion rate than ZOL at 12 months (86% vs 70%).
Conclusion
TPTD was more efficient than ZOL in bone formation and spinal fusion in OP patients who underwent TLIF.
Abbreviations
β-CTX, β cross-linked C-telopeptide of type 1 collagen; BMD, bone mineral density; BMI, body mass index; BTM, bone transformation marker; CI, confidence interval; CT, computed tomography; DXA, dual-energy X-ray absorption; FPPS, farnesyl pyrophosphate synthase; LDDs, lumbar degenerative diseases; P1NP, N-terminal propeptide of type 1 collagen; rhPTH (1-34), recombinant human parathyroid hormone (1-34); TLIF, transforaminal lumbar interbody fusion; TPTD, teriparatide; ODI, Oswestry Disability Index; OP, osteoporosis; VAS, visual analogue score; VCF, vertebral compression fracture; ZOL, zoledronic acid.
Data Sharing Statement
De-identified data can be available upon request from qualified academic investigators.
Ethics Approval and Consent to Participate
All participants provided written informed consent, and the study methods were conducted in accordance with the Declaration of Helsinki.
Consent for Publication
All participants provided publication consent of recordings and images.
Author Contributions
Research design: ZX Wang, CY Zhuang, H Lin, J Dong, etc.; collection of data: ZF Li, J Li, etc.; analysis and interpretation of data: ZX Wang, WX Chen, ZF Li, etc.; drafting and revision of paper: ZX Wang, CY Zhuang, H Lin, J Dong, etc. All authors made substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data; took part in drafting the article or revising it critically for important intellectual content; agreed to submit to the current journal; gave final approval of the version to be published; and agree to be accountable for all aspects of the work.
Disclosure
The authors report no conflicts of interest in this work.