BMC Musculoskeletal Disorders (Jul 2020)

Effect of bisphosphonates or teriparatide on mechanical complications after posterior instrumented fusion for osteoporotic vertebral fracture: a multi-center retrospective study

  • Atsuyuki Kawabata,
  • Toshitaka Yoshii,
  • Takashi Hirai,
  • Shuta Ushio,
  • Takashi Kaito,
  • Tomoya Yamashita,
  • Hiroyasu Fujiwara,
  • Yukitaka Nagamoto,
  • Yuji Matsuoka,
  • Hidekazu Suzuki,
  • Hirosuke Nishimura,
  • Hidetomi Terai,
  • Koji Tamai,
  • Atsushi Tagami,
  • Syuta Yamada,
  • Shinji Adachi,
  • Kei Watanabe,
  • Keiichi Katsumi,
  • Masayuki Ohashi,
  • Yohei Shibuya,
  • Katsumi Harimaya,
  • Kenichi Kawaguchi,
  • Nobuhiko Yokoyama,
  • Hidekazu Oishi,
  • Toshiro Doi,
  • Atsushi Kimura,
  • Hirokazu Inoue,
  • Gen Inoue,
  • Masayuki Miyagi,
  • Wataru Saito,
  • Atsushi Nakano,
  • Daisuke Sakai,
  • Tadashi Nukaga,
  • Shota Ikegami,
  • Masayuki Shimizu,
  • Toshimasa Futatsugi,
  • Seiji Ohtori,
  • Takeo Furuya,
  • Sumihisa Orita,
  • Shiro Imagama,
  • Kei Ando,
  • Kazuyoshi Kobayashi,
  • Katsuhito Kiyasu,
  • Hideki Murakami,
  • Katsuhito Yoshioka,
  • Shoji Seki,
  • Michio Hongo,
  • Kenichiro Kakutani,
  • Takashi Yurube,
  • Yasuchika Aoki,
  • Masashi Oshima,
  • Masahiko Takahata,
  • Akira Iwata,
  • Hirooki Endo,
  • Tetsuya Abe,
  • Toshinori Tsukanishi,
  • Kazuyoshi Nakanishi,
  • Kota Watanabe,
  • Tomohiro Hikata,
  • Satoshi Suzuki,
  • Norihiro Isogai,
  • Eijiro Okada,
  • Haruki Funao,
  • Seiji Ueda,
  • Yuta Shiono,
  • Kenya Nojiri,
  • Naobumi Hosogane,
  • Ken Ishii

DOI
https://doi.org/10.1186/s12891-020-03452-6
Journal volume & issue
Vol. 21, no. 1
pp. 1 – 10

Abstract

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Abstract Background The optimal treatment of osteoporosis after reconstruction surgery for osteoporotic vertebral fractures (OVF) remains unclear. In this multicentre retrospective study, we investigated the effects of typically used agents for osteoporosis, namely, bisphosphonates (BP) and teriparatide (TP), on surgical results in patients with osteoporotic vertebral fractures. Methods Retrospectively registered data were collected from 27 universities and affiliated hospitals in Japan. We compared the effects of BP vs TP on postoperative mechanical complication rates, implant-related reoperation rates, and clinical outcomes in patients who underwent posterior instrumented fusion for OVF. Data were analysed according to whether the osteoporosis was primary or glucocorticoid-induced. Results A total of 159 patients who underwent posterior instrumented fusion for OVF were included. The overall mechanical complication rate was significantly lower in the TP group than in the BP group (BP vs TP: 73.1% vs 58.2%, p = 0.045). The screw backout rate was significantly lower and the rates of new vertebral fractures and pseudoarthrosis tended to be lower in the TP group than in the BP group. However, there were no significant differences in lumbar functional scores and visual analogue scale pain scores or in implant-related reoperation rates between the two groups. The incidence of pseudoarthrosis was significantly higher in patients with glucocorticoid-induced osteoporosis (GIOP) than in those with primary osteoporosis; however, the pseudoarthrosis rate was reduced by using TP. The use of TP also tended to reduce the overall mechanical complication rate in both primary osteoporosis and GIOP. Conclusions The overall mechanical complication rate was lower in patients who received TP than in those who received a BP postoperatively, regardless of type of osteoporosis. The incidence of pseudoarthrosis was significantly higher in patients with GIOP, but the use of TP reduced the rate of pseudoarthrosis in GIOP patients. The use of TP was effective to reduce postoperative complications for OVF patients treated with posterior fusion.

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