Effect of teriparatide (PTH 1–34) on fusion mass and clinical outcomes the year after single-level instrumented posterolateral fusion

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Marta Martín-Fernández Ángel R. Piñera Félix Tomé-Bermejo Ignacio Mahillo-Fernández Francisco M. Garzon Luis Alvarez-Galovich


BACKGROUND CONTEXT: Successful spine fusion requires formation and remodeling of new bone. For this reason, osteoporosis is a risk factor that affects fusion in spine surgery. Parathyroid Hormone (PTH) is an anabolic drug that increases activity of osteoblasts and osteoclasts. Some studies have demonstrate the PTH accelerates the lumbar posterolateral fusion in osteoportic patients, but the clinical and functional impact of these medication is not well known

PURPOSE: To study the influence of the treatment with Teriparatide in the fusion mass and clinical outcome in a group of patients with osteoporosis and a lumbar posterolateral fusion during a 1-year follow-up.

METHODS: Seventy-two patients underwent a L4-L5 instrumental posterolateral fusion using pedicle screws and bone graft. Patients were divided into 2 groups: Treated with teriparatide (20µg/day, post-surgery, during 1 year) n= 47, or not treated n=25. Patients were studied before surgery and 3 months, 6 months and 1 year after surgery. The following assessments were performed: quality of bone fusion mass and clinical outcome evaluated by visual analogue scale score (VAS) and Oswestry Disability Index (ODI).

RESULTS: Radiographically, a decrease on the volume of fusion mass is observed in all cases, but this decrease was significantly lower in the group of patients treated with PTH. All patients have a significant improvement in pain and function. No differences in the improvement were observed between both groups.

CONCLUSIONS: A decrease on fusion mass volume was observed in all cases, but patients on Teriparatide treatment had a better fusion mass volume development. However, these radiological differences did not influence on clinical outcome at 1 year follow-up, as both groups present the same improvement.

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How to Cite
MARTÍN-FERNÁNDEZ, Marta et al. Effect of teriparatide (PTH 1–34) on fusion mass and clinical outcomes the year after single-level instrumented posterolateral fusion. Medical Research Archives, [S.l.], v. 6, n. 2, feb. 2018. ISSN 2375-1924. Available at: <https://esmed.org/MRA/mra/article/view/1687>. Date accessed: 28 nov. 2021. doi: https://doi.org/10.18103/mra.v6i2.1687.
Research Articles


[1] Hall MJ, DeFrance CJ, Williams SN, et al. National Hospital Discharge Survey: 2007 summary. Natl Health Stat Report 2010; 29: 1-20.
[2] Yoon ST, Boden SD. Spine fusion by gene teraphy. Gene Ther 2004; 11: 360-7.
[3] LI G, Patil CG, Lad SP, et al. Effects of age and comorbidities on complications rates and adverse outcomes after lumbar laminectomy in ederly patients. Spne 2008; 33: 1250-5.
[4] Brandon PH, Hirsch BP, Unnanuntana A, Cunningham ME, Lane JM.The effects of therapies for osteoporosis on spine fusion: a systematic review. Spine J 2013; 13: 190-99.
[5] Collinge C, Favela J. Use of teriparatide in osteoporotic fracture patients. Injury 2016; 47 Suppl 1: S36-8.
[6] O'Loughlin PF, Cunningham ME, Bukata SV et al. Parathyroid hormone (1-34) augments spinal fusion, fusion mass volume and fusion mass quality in a rabbit spinal fusion model. Spine (Phila Pa 1976) 2009; 15: 121-30.
[7] Lehman RA, Dmitriev AE, Cardoso MJ et al. Effect of teriparatide [rhPTH(1-34)] and calcitonin on intratransverse process fusion in a rabbit model. Spine (Phila Pa 1976) 2010; 35 146-52.
[8] Lina IA, Puvanesarajah V, Liauw JA et al. Quantitative study of parathyroid hormone (1-34) ad bone morphogenetic protein-2 on spinal fusion outcomes in a rabbit model of lumbar dorsolateral intertransverse process arthrodesis. Spine (Phila Pa 1976) 2014; 39: 347-55.
[9] Abe Y, Takahata M, Ito M et al. Enhancement of graft bone healing by intermittent administration of human parathyroid hormone (1-34) in a rat spinal arthrodesis model. Bone 2007; 41: 775-85.
[10] Ming N, Cheng JT, Rui YF et al. Dose-dependent enhancement of spinal fusion in rats with teriparatide (PTH[1-34]). Spine (Phila Pa 1976) 2012; 37:1275-82.
[11] Zhou Z, Tian FM, Gou Y et al. Enhancement of lumbar fusión and allevation of adjacent segment disc degeneration by intermittent PTH (1-34) in ovariectomized rats. J Bone Miner Res 2015; doi:10.1002/jbmr. 2736
[12] Qiu Z, Wei L, Liu J et al. Effect of intermittent PTH (1-34) on posterolateral spinal fusion with iliac crest bone graft in a ovariectomized rat model. Osteoporosis Int 2013; 24: 2693-700.
[13] Sugiura T, Masafumi K, Matsuo Y et al. Intermittent administration of teriparatide enhances graft bone healing and accelerates spinal fusion in rats with glucocorticoid-induced osteoporosis. Spine J 2015; 15: 298-306.
[14] Ohtori S, Inoue G, Sumishita O et al. Teriparatide accelerates lumbar posterolateral fusión in women with postmenopausal osteoporosis. Spine 2012; 37: E1464-8.
[15] Inoue G, Ueno M, Nakazawa T et al. Teriparatide increases the intersional torque of pedicle screws during fusion surgery in patients with postmenopausal osteoporosis. J Neurosurg Spine 2014; 21: 425-31.
[16] Fairbank JC, Pynsent PB. The Oswestry Disability Index. Spine 2000; 25: 2940-52.
[17] Andersen T, Christensen FB, Langdahl BL et al. Fusion mass bone quality after instrumented spinal fusion in older patients. European Spine Journal 2010; 19: 2200-08.
[18] Huang RC, Khan SN, Sandhu HS et al. Alendronate inhibits spine fusión in a rat model. Spine 2005; 30: 2516-22.
[19] Xue Q, Li H, Zou X et al. The influence of alendronate treatment and bone graft volume on posterior lateral spine fusion in a porcine model. Spine 2005; 30: 1116-21.
[20] Takahata M, Ito M, Abe Y et al. The effect of anti-resorptive therapies on bone graft healing in an ovariectomized rat spinal arthrodesis model. Bone 2008; 43: 1057-66.
[21] Sama AA, Kan SN, Myers ER et al. High dose alendronate uncouples osteoclast and osteoblast function: a study in a rat spine pseudoarthrosis model. Clin Orthop Relat Res 2004; 425: 135-42.
[22] Nagahama K, Kanayama M, Togawa D et al. Does alendronate disturb the healing process of posterior lumbar interbody fusion? A prospective randomized trial. J Neurosurg Spine 2011; 14: 500-7.
[23] Boden SD. Overview of the biology of lumbar spine fusion and principles for selecting a bone graft substitute. Spine 2002; 27: S26-31.
[24] Park YS, Kim HS, Baek SW, Kong DY, Ryu JA. The effect of zoledronic acid on the volume of the fusion-mass in lumbar spinal fusion. Clin Orthop Surg 2013; 5: 292-97.
[25] Chen F, Dai Z, Kang Y, Ly G, Keller ET, Jiang Y. Effects of zoledronic acid on bone fusion in osteoporotic patients after lumbar fusion. Osteoporosis Int 2016; 27: 1469-76.
[26] Kanaya K, Kato Y, Murata Y et al. Low parathyroid hormone levels in patients who underwent/would undergo hemodialysis result in bone graft failure after posterolateral fusion. Spine (Phila Pa 1976) 2014; 39:327-31.
[27] PIñera AR, Durán C, López B, Saez I, Correia E, Alvarez L. Instrumented lumbar arthrodesis in ederly patients: prospective study usig canulated cemented pedicle screw instrumentation. Eur Spine J 2011; 20 Suppl 3: 408-14.
[28] Bulmann V, LIljenqvist UR, Rödi R, Schulte TL. Pedicle screw augmentation from a biochemical perspective. Orthopade 2010; 39: 673-8.