Teriparatide improves volumetric bone mineral density and fine bone structure in the UIV+1 vertebra, and reduces bone failure type PJK after surgery for adult spinal deformity

Mitsuru Yagi, H. Ohne, T. Konomi, K. Fujiyoshi, S. Kaneko, T. Komiyama, M. Takemitsu, Y. Yato, M. Machida, T. Asazuma

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Abstract

Summary: We conducted a prospective comparative study of the effect of teriparatide therapy for preventing vertebral-failure-type PJK after reconstructive surgery for adult spinal deformity. Prophylactic teriparatide improved the volumetric bone mineral density and fine bone structure of the vertebra above the upper-instrumented vertebra and reduced the incidence of vertebral-failure-type PJK. Introduction: Proximal junctional kyphosis (PJK) is a complication after corrective surgery for spinal deformity. This study sought to determine whether teriparatide (TP) is an effective prophylactic against PJK type 2 (vertebral fracture) in surgically treated patients with adult spinal deformity (ASD). Methods: Forty-three patients who started TP therapy immediately after surgery and 33 patients who did not receive TP were enrolled in this prospective case series. These patients were female, over 50, surgically treated for ASD, and followed for at least 2 years. Preoperative and postoperative standing whole-spine X-rays and dual-energy X-ray absorptiometry scans, and multidetector CT images obtained before and 6 months after surgery were used to analyze the bone strength in the vertebra above the upper-instrumented vertebra (UIV+1). Results: Mean age was 67.9 years. After 6 months of treatment, mean hip-bone mineral density (BMD) increased from 0.721 to 0.771 g/cm2 in the TP group and decreased from 0.759 to 0.729 g/cm2 in the control group. This percent BMD change between groups was significant (p < 0.05). The volumetric BMD (326 to 366 mg/cm3) and bone mineral content (BMC) (553 to 622 mg) at UIV+1 were also significantly increased in TP group. The bone volume/tissue volume ratio increased from 46 to 54 % in the TP group, and the trabecular bone thickness and number increased by 14 and 5 %, respectively. At the 2-year follow-up, the PJK type 2 incidence was significantly lower in the TP group (4.6 %) than in the control group (15.2 %; p = .02). Conclusions: Prophylactic TP treatment improved the volumetric BMD and fine bone structure at UIV+1 and reduced the PJK-type 2 incidence.

Original languageEnglish
Pages (from-to)1-8
Number of pages8
JournalOsteoporosis International
DOIs
Publication statusAccepted/In press - 2016 Jun 24

Fingerprint

Teriparatide
Kyphosis
Bone Density
Spine
Bone and Bones
Incidence
Reconstructive Surgical Procedures
Pelvic Bones
Control Groups
Photon Absorptiometry
Therapeutics
X-Rays
Prospective Studies

Keywords

  • Adult spinal deformity
  • Osteoporosis
  • PJK
  • Teriparatide

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism

Cite this

Teriparatide improves volumetric bone mineral density and fine bone structure in the UIV+1 vertebra, and reduces bone failure type PJK after surgery for adult spinal deformity. / Yagi, Mitsuru; Ohne, H.; Konomi, T.; Fujiyoshi, K.; Kaneko, S.; Komiyama, T.; Takemitsu, M.; Yato, Y.; Machida, M.; Asazuma, T.

In: Osteoporosis International, 24.06.2016, p. 1-8.

Research output: Contribution to journalArticle

Yagi, Mitsuru ; Ohne, H. ; Konomi, T. ; Fujiyoshi, K. ; Kaneko, S. ; Komiyama, T. ; Takemitsu, M. ; Yato, Y. ; Machida, M. ; Asazuma, T. / Teriparatide improves volumetric bone mineral density and fine bone structure in the UIV+1 vertebra, and reduces bone failure type PJK after surgery for adult spinal deformity. In: Osteoporosis International. 2016 ; pp. 1-8.
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AU - Yagi, Mitsuru

AU - Ohne, H.

AU - Konomi, T.

AU - Fujiyoshi, K.

AU - Kaneko, S.

AU - Komiyama, T.

AU - Takemitsu, M.

AU - Yato, Y.

AU - Machida, M.

AU - Asazuma, T.

PY - 2016/6/24

Y1 - 2016/6/24

N2 - Summary: We conducted a prospective comparative study of the effect of teriparatide therapy for preventing vertebral-failure-type PJK after reconstructive surgery for adult spinal deformity. Prophylactic teriparatide improved the volumetric bone mineral density and fine bone structure of the vertebra above the upper-instrumented vertebra and reduced the incidence of vertebral-failure-type PJK. Introduction: Proximal junctional kyphosis (PJK) is a complication after corrective surgery for spinal deformity. This study sought to determine whether teriparatide (TP) is an effective prophylactic against PJK type 2 (vertebral fracture) in surgically treated patients with adult spinal deformity (ASD). Methods: Forty-three patients who started TP therapy immediately after surgery and 33 patients who did not receive TP were enrolled in this prospective case series. These patients were female, over 50, surgically treated for ASD, and followed for at least 2 years. Preoperative and postoperative standing whole-spine X-rays and dual-energy X-ray absorptiometry scans, and multidetector CT images obtained before and 6 months after surgery were used to analyze the bone strength in the vertebra above the upper-instrumented vertebra (UIV+1). Results: Mean age was 67.9 years. After 6 months of treatment, mean hip-bone mineral density (BMD) increased from 0.721 to 0.771 g/cm2 in the TP group and decreased from 0.759 to 0.729 g/cm2 in the control group. This percent BMD change between groups was significant (p < 0.05). The volumetric BMD (326 to 366 mg/cm3) and bone mineral content (BMC) (553 to 622 mg) at UIV+1 were also significantly increased in TP group. The bone volume/tissue volume ratio increased from 46 to 54 % in the TP group, and the trabecular bone thickness and number increased by 14 and 5 %, respectively. At the 2-year follow-up, the PJK type 2 incidence was significantly lower in the TP group (4.6 %) than in the control group (15.2 %; p = .02). Conclusions: Prophylactic TP treatment improved the volumetric BMD and fine bone structure at UIV+1 and reduced the PJK-type 2 incidence.

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KW - Adult spinal deformity

KW - Osteoporosis

KW - PJK

KW - Teriparatide

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