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Osteoporosis International

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Open Access 01-05-2012 | Original Article

Prospective comparison of the therapeutic effect of teriparatide with that of combined vertebroplasty with antiresorptive agents for the treatment of new-onset adjacent vertebral compression fracture after percutaneous vertebroplasty

Authors: Y.-Y. Tseng, C.-H. Su, T.-N. Lui, Y.-S. Yeh, S.-H. Yeh

Published in: Osteoporosis International | Issue 5/2012

Abstract

Summary

Most post-vertebroplasty new-onset adjacent vertebral compression fractures (VCFs) occur within 2–3 months, and antiresorptive agents do not significantly reduce the risk of their occurrence. In opposite mechanism, teriparatide directly stimulates bone formation and improves bone strength and quality faster. The therapeutic effect of teriparatide is better than that of vertebroplasty combined with an antiresorptive treatment and is a potentially useful therapy for new-onset adjacent VCFs after vertebroplasty.

Introduction

Following vertebroplasty, patients are at increased risk of new-onset adjacent-level VCFs. The therapeutic effect of antiresorptive agents is too slow, and they are associated with the risk of new VCFs. Teriparatide markedly increases bone formation and strength and reduces the incidence of new-onset VCFs. This prospective cohort study compared the therapeutic effects of teriparatide with those of combined vertebroplasty and an anti-resorber for treating new-onset adjacent VCFs after vertebroplasty.

Methods

Fifty patients with adjacent VCFs were randomly assigned to two groups: teriparatide only (group A) and additional vertebroplasty combined with an antiresorptive agent (group B). Relevant clinical data of the two groups were prospectively compared.

Results

The 22 patients in group A were at higher risk of new VCFs than those in group B (22 patients); they were older and had more pre-existing fractures (p < 0.05). Patients treated with teriparatide had a significantly lower incidence of new-onset VCFs (odds ratio = 0.21; 95% confidence interval, 0.02–2.10). Teriparatide-mediated VCF reduction was 78.57%, which was markedly better than that of group B. The teriparatide group had a significant decrease in the visual analog scale and an increase in the Japanese Orthopedic Association low back pain score after 6 months of treatment (p < 0.05). The increase in lumbar spine BMD was marked in the teriparatide group (21.70% vs. 6.87%) after an 18-month treatment.

Conclusions

Treatment of post-vertebroplasty adjacent VCFs with teriparatide (no new vertebroplasty) was more effective than that of repeated vertebroplasties combined with an anti-resorber.

Hall SE, Criddle RA, Comito TL, Prince RL (1999) A case-control study of quality of life and functional impairment in women with long-standing vertebral osteoporotic fracture. Osteoporos Int 9:508–515PubMedCrossRef

Sambrook P, Cooper C (2006) Osteoporosis. Lancet 367:2010–2018PubMedCrossRef

Ploeg WT, Veldhuizen AG, The B, Sietsma MS (2006) Percutaneous vertebroplasty as a treatment for osteoporotic vertebral compression fractures: a systematic review. Eur Spine J 15:1749–1758PubMedCrossRef

Mudano AS, Bian J, Cope JU, Curtis JR, Gross TP, Allison JJ, Kim Y, Briggs D, Melton ME, Xi J, Saag KG (2009) Vertebroplasty and kyphoplasty are associated with an increased risk of secondary vertebral compression fractures: a population-based cohort study. Osteoporos Int 20:819–826PubMedCrossRef

Boger A, Heini P, Windolf M, Schneider E (2007) Adjacent vertebral failure after vertebroplasty: a biomechanical study of low-modulus PMMA cement. Eur Spine J 16:2118–2125PubMedCrossRef

Trout AT, Kallmes DF, Kaufmann TJ (2006) New fractures after vertebroplasty: adjacent fractures occur significantly sooner. Ajnr 27:217–223PubMed

Voormolen MH, Lohle PN, Juttmann JR, van der Graaf Y, Fransen H, Lampmann LE (2006) The risk of new osteoporotic vertebral compression fractures in the year after percutaneous vertebroplasty. J Vasc Interv Radiol 17:71–76PubMedCrossRef

Tseng YY, Yang TC, Tu PH, Lo YL, Yang ST (2009) Repeated and multiple new vertebral compression fractures after percutaneous transpedicular vertebroplasty. Spine 34:1917–1922PubMedCrossRef

Black DM, Cummings SR, Karpf DB, Cauley JA, Thompson DE, Nevitt MC, Bauer DC, Genant HK, Haskell WL, Marcus R, Ott SM, Torner JC, Quandt SA, Reiss TF, Ensrud KE (1996) Randomised trial of effect of alendronate on risk of fracture in women with existing vertebral fractures. Fracture Intervention Trial Research Group. Lancet 348:1535–1541PubMedCrossRef

10.

Ettinger B, Black DM, Mitlak BH, Knickerbocker RK, Nickelsen T, Genant HK, Christiansen C, Delmas PD, Zanchetta JR, Stakkestad J, Gluer CC, Krueger K, Cohen FJ, Eckert S, Ensrud KE, Avioli LV, Lips P, Cummings SR (1999) Reduction of vertebral fracture risk in postmenopausal women with osteoporosis treated with raloxifene: results from a 3-year randomized clinical trial. Multiple Outcomes of Raloxifene Evaluation (MORE) Investigators. Jama 282:637–645PubMedCrossRef

11.

Kaufman JM, Orwoll E, Goemaere S, San Martin J, Hossain A, Dalsky GP, Lindsay R, Mitlak BH (2005) Teriparatide effects on vertebral fractures and bone mineral density in men with osteoporosis: treatment and discontinuation of therapy. Osteoporos Int 16:510–516PubMedCrossRef

12.

Marcus R, Wang O, Satterwhite J, Mitlak B (2003) The skeletal response to teriparatide is largely independent of age, initial bone mineral density, and prevalent vertebral fractures in postmenopausal women with osteoporosis. J Bone Miner Res 18:18–23PubMedCrossRef

13.

Arlot M, Meunier PJ, Boivin G, Haddock L, Tamayo J, Correa-Rotter R, Jasqui S, Donley DW, Dalsky GP, Martin JS, Eriksen EF (2005) Differential effects of teriparatide and alendronate on bone remodeling in postmenopausal women assessed by histomorphometric parameters. J Bone Miner Res 20:1244–1253PubMedCrossRef

14.

Genant HK, Wu CY, van Kuijk C, Nevitt MC (1993) Vertebral fracture assessment using a semiquantitative technique. J Bone Miner Res 8:1137–1148PubMedCrossRef

15.

Scott PJ, Huskisson EC (1977) Measurement of functional capacity with visual analogue scales. Rheumatol Rehabil 16:257–259PubMedCrossRef

16.

Fukui M, Chiba K, Kawakami M, Kikuchi S, Konno S, Miyamoto M, Seichi A, Shimamura T, Shirado O, Taguchi T, Takahashi K, Takeshita K, Tani T, Toyama Y, Yonenobu K, Wada E, Tanaka T, Hirota Y (2007) Japanese Orthopaedic Association Back Pain Evaluation Questionnaire. Part 2. Verification of its reliability: The Subcommittee on Low Back Pain and Cervical Myelopathy Evaluation of the Clinical Outcome Committee of the Japanese Orthopaedic Association. J Orthop Sci 12:526–532PubMedCrossRef

17.

Majumdar SR, Kim N, Colman I, Chahal AM, Raymond G, Jen H, Siminoski KG, Hanley DA, Rowe BH (2005) Incidental vertebral fractures discovered with chest radiography in the emergency department: prevalence, recognition, and osteoporosis management in a cohort of elderly patients. Arch Intern Med 165:905–909PubMedCrossRef

18.

Buchbinder R, Osborne RH, Ebeling PR, Wark JD, Mitchell P, Wriedt C, Graves S, Staples MP, Murphy B (2009) A randomized trial of vertebroplasty for painful osteoporotic vertebral fractures. The New Engl J Med 361:557–568CrossRef

19.

Buchbinder R, Osborne RH, Kallmes D (2009) Vertebroplasty appears no better than placebo for painful osteoporotic spinal fractures, and has potential to cause harm. The Med J Australia 191:476–477

20.

Kallmes DF, Comstock BA, Heagerty PJ, Turner JA, Wilson DJ, Diamond TH, Edwards R, Gray LA, Stout L, Owen S, Hollingworth W, Ghdoke B, Annesley-Williams DJ, Ralston SH, Jarvik JG (2009) A randomized trial of vertebroplasty for osteoporotic spinal fractures. The New Engl J Med 361:569–579CrossRef

21.

Lin CC, Shen WC, Lo YC, Liu YJ, Yu TC, Chen IH, Chung HW (2010) Recurrent pain after percutaneous vertebroplasty. Ajr 194:1323–1329PubMedCrossRef

22.

Nevitt MC, Chen P, Kiel DP, Reginster JY, Dore RK, Zanchetta JR, Glass EV, Krege JH (2006) Reduction in the risk of developing back pain persists at least 30 months after discontinuation of teriparatide treatment: a meta-analysis. Osteoporos Int 17:1630–1637PubMedCrossRef

23.

Nevitt MC, Chen P, Dore RK, Reginster JY, Kiel DP, Zanchetta JR, Glass EV, Krege JH (2006) Reduced risk of back pain following teriparatide treatment: a meta-analysis. Osteoporos Int 17:273–280PubMedCrossRef

24.

McClung MR, San Martin J, Miller PD, Civitelli R, Bandeira F, Omizo M, Donley DW, Dalsky GP, Eriksen EF (2005) Opposite bone remodeling effects of teriparatide and alendronate in increasing bone mass. Arch Intern Med 165:1762–1768PubMedCrossRef

25.

Ulivieri FM (2007) Back pain treatment in post-menopausal osteoporosis with vertebral fractures. Aging Clin Exp Res 19:21–23PubMed

26.

Genant HK, Halse J, Briney WG, Xie L, Glass EV, Krege JH (2005) The effects of teriparatide on the incidence of back pain in postmenopausal women with osteoporosis. Curr Med Res Opin 21:1027–1034PubMedCrossRef

27.

Polikeit A, Nolte LP, Ferguson SJ (2003) The effect of cement augmentation on the load transfer in an osteoporotic functional spinal unit: finite-element analysis. Spine 28:991–996PubMed

28.

Nouda S, Tomita S, Kin A, Kawahara K, Kinoshita M (2009) Adjacent vertebral body fracture following vertebroplasty with polymethylmethacrylate or calcium phosphate cement: biomechanical evaluation of the cadaveric spine. Spine 34:2613–2618PubMedCrossRef

29.

Delmas PD, Bjarnason NH, Mitlak BH, Ravoux AC, Shah AS, Huster WJ, Draper M, Christiansen C (1997) Effects of raloxifene on bone mineral density, serum cholesterol concentrations, and uterine endometrium in postmenopausal women. The New Engl J Med 337:1641–1647CrossRef

30.

Bone HG, Hosking D, Devogelaer JP, Tucci JR, Emkey RD, Tonino RP, Rodriguez-Portales JA, Downs RW, Gupta J, Santora AC, Liberman UA (2004) Ten years' experience with alendronate for osteoporosis in postmenopausal women. The New Engl J Med 350:1189–1199CrossRef

31.

Body JJ, Gaich GA, Scheele WH, Kulkarni PM, Miller PD, Peretz A, Dore RK, Correa-Rotter R, Papaioannou A, Cumming DC, Hodsman AB (2002) A randomized double-blind trial to compare the efficacy of teriparatide [recombinant human parathyroid hormone (1–34)] with alendronate in postmenopausal women with osteoporosis. J Clin Endocrinol Metab 87:4528–4535PubMedCrossRef

32.

Wasnich RD, Miller PD (2000) Antifracture efficacy of antiresorptive agents are related to changes in bone density. J Clin Endocrinol Metab 85:231–236PubMedCrossRef

33.

Hernandez CJ, Beaupre GS, Marcus R, Carter DR (2001) A theoretical analysis of the contributions of remodeling space, mineralization, and bone balance to changes in bone mineral density during alendronate treatment. Bone 29:511–516PubMedCrossRef

34.

Chen P, Miller PD, Delmas PD, Misurski DA, Krege JH (2006) Change in lumbar spine BMD and vertebral fracture risk reduction in teriparatide-treated postmenopausal women with osteoporosis. J Bone Miner Res 21:1785–1790PubMedCrossRef

35.

Glover SJ, Eastell R, McCloskey EV, Rogers A, Garnero P, Lowery J, Belleli R, Wright TM, John MR (2009) Rapid and robust response of biochemical markers of bone formation to teriparatide therapy. Bone 45:1053–1058PubMedCrossRef

36.

Jiang Y, Zhao JJ, Mitlak BH, Wang O, Genant HK, Eriksen EF (2003) Recombinant human parathyroid hormone (1–34) [teriparatide] improves both cortical and cancellous bone structure. J Bone Miner Res 18:1932–1941PubMedCrossRef

37.

Chen P, Miller PD, Recker R, Resch H, Rana A, Pavo I, Sipos AA (2007) Increases in BMD correlate with improvements in bone microarchitecture with teriparatide treatment in postmenopausal women with osteoporosis. J Bone Miner Res 22:1173–1180PubMedCrossRef

38.

Blick SK, Dhillon S, Keam SJ (2008) Teriparatide: a review of its use in osteoporosis. Drugs 68:2709–2737PubMedCrossRef

39.

Boonen S, Marin F, Mellstrom D, Xie L, Desaiah D, Krege JH, Rosen CJ (2006) Safety and efficacy of teriparatide in elderly women with established osteoporosis: bone anabolic therapy from a geriatric perspective. J Am Geriatr Soc 54:782–789PubMedCrossRef

40.

Abrahamsen B, Hansen TB, Jensen LB, Hermann AP, Eiken P (1997) Site of osteodensitometry in perimenopausal women: correlation and limits of agreement between anatomic regions. J Bone Miner Res 12:1471–1479PubMedCrossRef

41.

Miller PD, Zapalowski C, Kulak CA, Bilezikian JP (1999) Bone densitometry: the best way to detect osteoporosis and to monitor therapy. J Clin Endocrinol Metab 84:1867–1871PubMedCrossRef

42.

Prince R, Sipos A, Hossain A, Syversen U, Ish-Shalom S, Marcinowska E, Halse J, Lindsay R, Dalsky GP, Mitlak BH (2005) Sustained nonvertebral fragility fracture risk reduction after discontinuation of teriparatide treatment. J Bone Miner Res 20:1507–1513PubMedCrossRef

43.

Lindsay R, Scheele WH, Neer R, Pohl G, Adami S, Mautalen C, Reginster JY, Stepan JJ, Myers SL, Mitlak BH (2004) Sustained vertebral fracture risk reduction after withdrawal of teriparatide in postmenopausal women with osteoporosis. Arch Intern Med 164:2024–2030PubMedCrossRef

Title: Prospective comparison of the therapeutic effect of teriparatide with that of combined vertebroplasty with antiresorptive agents for the treatment of new-onset adjacent vertebral compression fracture after percutaneous vertebroplasty
Authors: Y.-Y. Tseng
C.-H. Su
T.-N. Lui
Y.-S. Yeh
S.-H. Yeh
Publication date: 01-05-2012
Publisher: Springer-Verlag
Published in: Osteoporosis International / Issue 5/2012
Print ISSN: 0937-941X
Electronic ISSN: 1433-2965
DOI: https://doi.org/10.1007/s00198-011-1730-y

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Prospective comparison of the therapeutic effect of teriparatide with that of combined vertebroplasty with antiresorptive agents for the treatment of new-onset adjacent vertebral compression fracture after percutaneous vertebroplasty

Abstract

Summary

Introduction

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Summary

Introduction

Methods

Results

Conclusions

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