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Sergeenko OM, Savin DM, Evsyukov AV, Burtsev AV. Reliability and validity of the pediatric adaptation of the mJOA scale for evaluating cervical spine disorders. Spine Deform 2024:10.1007/s43390-024-00931-x. [PMID: 39026126 DOI: 10.1007/s43390-024-00931-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 07/13/2024] [Indexed: 07/20/2024]
Abstract
PURPOSE The study aimed to evaluate the validity and reliability of the pediatric adaptation of the Japanese Orthopedic Association (mJOA) scale in pediatric patients with various cervical spine pathologies. METHODS Initial assessments were performed by a neurosurgeon, followed by an independent evaluation by a neurologist within 1-2 days to test inter-rater reliability. The same clinician assessed the same group of children using the adapted mJOA scale at different point in time (between 1 month and 1 year after the initial assessment) to test intra-rater reliability. For known-groups validity, the pediatric mJOA scale assessments were compared between two groups of pathologies with different prognosis. Concurrent validity was assessed against the McCormick scale, and convergent validity was tested by reassessing patients using the adult mJOA scale two or more years after the initial assessment by pediatric one. RESULTS A cohort of 169 pediatric patients aged 6 months to 18 years (mean age: 10 ± 4.6 years) with various cervical spine pathologies was recruited. Pathologies included atlanto-axial rotatory fixation (AARF), Chiari type I anomaly, congenital cervical spine scoliosis, atlanto-axial dislocation (AAD) and instability (AAI), cervical spine stenosis and trauma, and congenital cervicothoracic dislocations. The majority of patients underwent cervical spine surgery and were followed up for an average of 6.9 ± 2.97 years. The pediatric mJOA scale demonstrated high inter-rater reliability (r = 0.99, p < 0.0001) and strong intra-rater reliability (r = 0.82, p < 0.0001). Significant differences in pediatric mJOA scores were observed between patients with expected-intact neurological status and those with expected-pathological neurological status (p < 0.0001). The pediatric mJOA scale showed a strong correlation with the McCormick grading system (r = 0.97, p < 0.001) and good correlation with the adult mJOA scale during long-term follow-up (r = 0.82, p < 0.0001). CONCLUSIONS The pediatric version of the mJOA scale is a reliable and valid tool for assessing pediatric patients with cervical spine disorders. Its high reliability and validity support its use in both clinical practice and research.
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Affiliation(s)
| | - Dmitry M Savin
- Division of Spinal Surgery, Ilizarov Center, Kurgan, Russia
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Ko MJ, Lee BJ. Kummell's Disease is Becoming Increasingly Important in an Aging Society: A Review. Korean J Neurotrauma 2023; 19:32-41. [PMID: 37051029 PMCID: PMC10083447 DOI: 10.13004/kjnt.2023.19.e13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/08/2023] [Accepted: 03/08/2023] [Indexed: 03/28/2023] Open
Abstract
Kummell's disease (KD) is referred to as delayed posttraumatic vertebral collapse, avascular necrosis of vertebrae, or ischemic vertebral collapse. KD is no longer rare in an aging society. It is mainly caused by minor trauma, and nonunion occurs secondary to avascular necrosis at the vertebral body fracture site, which can lead to vertebral kyphosis or intravertebral instability. Clinical symptoms of KD range from no symptoms to severe paralysis due to nerve injury. KD is considered a complication of osteoporotic vertebral compression fractures, and conservative treatment, including osteoporosis treatment, is important. Timely interventions such as vertebral augmentation or surgery, with active regular follow-up are necessary before the onset of neurological deficits due to osteonecrotic collapse in patients with suspected KD. In this study, we summarize the pathogenesis, diagnosis, and treatment of KD, which is showing increasing prevalence in an aging society. We have presented a literature review and discussed clinical guidelines and therapeutic strategies to reduce the morbidity and mortality associated with KD.
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Affiliation(s)
- Myeong Jin Ko
- Department of Neurosurgery, College of Medicine, Chung-Ang University Hospital, Seoul, Korea
| | - Byung-Jou Lee
- Department of Neurosurgery and Neuroscience & Radiosurgery Hybrid Research Center, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
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3
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Gou P, Zhao Z, Yu C, Hou X, Gao G, Zhang T, Chang F. Efficacy of Recombinant Human Parathyroid Hormone versus Vertebral Augmentation Procedure on Patients with Acute Osteoporotic Vertebral Compression Fracture. Orthop Surg 2022; 14:2510-2518. [PMID: 36017765 PMCID: PMC9531108 DOI: 10.1111/os.13470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 07/25/2022] [Accepted: 07/26/2022] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE Although widely used in clinical practice, vertebral augmentation procedure (VAP) for osteoporotic vertebral compression fracture (OVCF) is not supported. Recently, the effect of recombinant human parathyroid hormone (1-34) (rhPTH) has been paid great attention for its efficacy in anti-osteoporosis and bone union. This study aims to explore the outcome of rhPTH on acute OVCF and compare it with VAP to clarify its therapeutic advantages. METHODS The retrospective study comprised 71 acute OVCF patients from January 2015 to March 2020: 22 received rhPTH treatment (rhPTH group) and 49 underwent VAP (VAP group). The rhPTH group was 15 women and seven men with an average of 76.18 years, and the VAP group were 35 women and 14 men with an average of 73.63 years. The thoracic/lumbar vertebrae were 14/8 in the rhPTH group and 29/20 in the VAP group. The average follow-up period was 14.05 months in the rhPTH group and 13.82 months in the VAP group. The two groups were assessed regarding the visual analog score (VAS), Oswestry Disability Index (ODI), OVCF bone union, bone mineral density (BMD), kyphotic angle (KA), anterior and posterior border height (ABH and PBH, respectively), adverse events and the health-related quality of life assessed by short form-36 health survey scores (SF-36). Categorical variables were analyzed by chi-square test and continuous variables between groups were analyzed by independent samples t-test or Mann-Whitney U test according to the normality. RESULTS During the follow-up, the VAS was significantly lower in the rhPTH group than in the VAP group at month 3 (0.39 ± 0.6 vs 0.68 ± 0.651) (p = 0.047), month 6 (0.45 ± 0.60 vs 2.18 ± 1.22) (p < 0.001), and month 12 (0.45 ± 0.60 vs 2.43 ± 1.49) (p < 0.001). At month 12, the ODI was significantly lower in the rhPTH group (18.59 ± 3.33%) than in the VAP group (28.93 ± 16.71%) (p < 0.001). Bone bridge was detected on sagittal computed tomography images of all fractured vertebrae in the rhPTH group. The BMD was significantly higher in the rhPTH group (87.66 ± 5.91 Hounsfield units [HU]) than in the VAP group (68.15 ± 11.32HU) (p < 0.001). There were no significant differences in the changes in KA, ABH, and PBH between groups (all p > 0.05). The incidence of new OVCF was significantly lower in the rhPTH group than in the VAP group (p = 0.042). All scores of SF-36 were significantly higher in the rhPTH group than in the VAP group (all p < 0.05). CONCLUSION In acute OVCF patients, rhPTH was better than VAP in increasing spinal BMD to promote OVCF healing, reduce new OVCF, and improve back pain, physical ability, and health-related quality of life.
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Affiliation(s)
- Pengguo Gou
- Department of Orthopedic Surgery, The Fifth Affiliated Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Zhihui Zhao
- Department of Orthopedic Surgery, The Tianjin 4th Centre Hospital, Tianjin, Tianjin, China
| | - Chen Yu
- Department of Orthopedic Surgery, The Fifth Affiliated Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Xuefeng Hou
- Department of Orthopedic Surgery, The Fifth Affiliated Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Gang Gao
- Department of Orthopedic Surgery, The Fifth Affiliated Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Ting Zhang
- Department of Orthopedic Surgery, The Fifth Affiliated Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Feng Chang
- Department of Orthopedic Surgery, The Fifth Affiliated Hospital of Shanxi Medical University, Taiyuan, Shanxi, China
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4
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Eastman K, Gerlach M, Piec I, Greeves J, Fraser W. Effectiveness of parathyroid hormone (PTH) analogues on fracture healing: a meta-analysis. Osteoporos Int 2021; 32:1531-1546. [PMID: 33559713 DOI: 10.1007/s00198-021-05847-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 01/12/2021] [Indexed: 12/21/2022]
Abstract
UNLABELLED This meta-analysis evaluated the evidence for the use of parathyroid hormone (PTH) analogues to improve fracture healing. Eligible studies were prospective randomised controlled trials of adults with acute fractures treated with a PTH analogue. PTH improved functional outcomes but did not affect fracture healing rate or reduce pain. PURPOSE This meta-analysis evaluated the evidence of parathyroid hormone (PTH) analogues in fracture healing. The use of PTH analogues to prevent osteoporotic fractures is well investigated, and studies are emerging on extended indications. One such indication receiving increasing attention is the effect of PTH in fracture healing; however, the overall degree of efficacy remains inconclusive. METHODS A systematic electronic database search of MEDLINE, EMBASE and the Cochrane Library was conducted for relevant articles in August 2019 with no date restrictions. Randomised controlled trials of adults with acute fractures treated with a PTH analogue were included. PTH was compared with a comparator intervention, placebo or no treatment. RESULTS PTH analogue treatment improved functional outcomes in a range of fracture types but did not affect the fracture healing rate or reduce pain. Most trials included in this review were in elderly patients with osteoporosis. There was no evidence that PTH treatment caused harm or impeded fracture healing. CONCLUSIONS Meta-analysis of published data supports the use of PTH analogues to improve functional outcomes but not fracture healing rate or pain for different fracture types. The evidence for PTH analogue use in fracture healing is less clear in younger, non-osteoporotic patient populations. Trial design was heterogeneous and of limited quality, justifying further original trials.
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Affiliation(s)
- K Eastman
- Norwich Medical School, University of East Anglia, Norwich, UK.
| | - M Gerlach
- Norfolk and Norwich University Hospital, Norwich, UK
| | - I Piec
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - J Greeves
- Norwich Medical School, University of East Anglia, Norwich, UK
- Department of Army Health and Performance Research, Andover, Hampshire, UK
| | - W Fraser
- Norwich Medical School, University of East Anglia, Norwich, UK
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5
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Gou P, Wang Z, Zhao Z, Wang Y, Jiang Y, Xue Y. Restoration of the intravertebral stability in Kümmell's disease following the treatment of severe postmenopausal osteoporosis by 1-34PTH-a retrospective study. Osteoporos Int 2021; 32:1451-1459. [PMID: 33471147 DOI: 10.1007/s00198-020-05761-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 11/23/2020] [Indexed: 12/18/2022]
Abstract
UNLABELLED Following the 1-34PTH application for conservative treatment of Kümmell's disease, the intravertebral cleft was filled or bridged by the osseous tissue; the radiological evidence of further collapsing was absent. Pain and the neurological disorder were relieved; bone turnover markers, BMD as well as the health-related quality of life were improved. INTRODUCTION Kümmell's disease (KD) patients with severe osteoporosis were applied by the 1-34PTH; the fracture union and the increased bone mineral density (BMD) following this treatment were retrospectively reviewed. METHODS Twenty-one postmenopausal osteoporosis (PMOP) patients with KD received at least 6 months of 1-34PTH treatment. The medical records, including clinical evaluation symptoms, radiological evaluation for bone union and the stability of intravertebral vacuum cleft (IVC), BMD, and laboratory examination for osteoporosis recovery and health-related quality of life (HRQOL), were reviewed. RESULTS From baseline to month 12, visual analog scale decreased from 8.24 ± 0.54 to 1.71 ± 0.56 (P < 0.001) and the modified Japanese Orthopedic Association scores increased from 6.86 ± 1.77 to 10.43 ± 1.29 (P < 0.001). Sagittal CT demonstrated that the IVC was filled or bridged by the osseous tissue in all patients. Within the vertebra, the IVC area (IVCA) decreased from 4.50 ± 2.50 to 0 mm2 (P = 0.001) and the mineralized bone area (MBA) increased from 170.91 ± 102.23 to 259.56 ± 98.60 mm2 (P < 0.001). The area ratio of IVC to vertebra decreased from 0.97 ± 0.46 to 0% (P < 0.001), and the area ratio of mineral bone to vertebra was increased from 32.85 ± 14.51 to 54.97 ± 14.01% (P < 0.001). The kyphosis angle increment was 3.43 ± 1.80°, and the loss rate of anterior border height was 11.14 ± 4.82%. No differences were found in posterior border height and spinal canal diameter. The PINP, β-CTx, BMD, and Short Form-36 Health Survey scores markedly increased. CONCLUSIONS In KD patients with severe PMOP, 1-34PTH treatment could alleviate the clinical evaluation symptoms, facilitate the recovery of the intravertebral stability, ameliorate the BMD, and improve the HRQoL.
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Affiliation(s)
- P Gou
- Department of Orthopedics Surgery, Tianjin Medical University General Hospital, Tianjin, 300052, China
- Key Laboratory of Spine and Spinal Cord, Tianjin Medical University General Hospital, Tianjin, 300052, China
- Department of Orthopedics Surgery, The Fifth People's Hospital of Datong, Ping Cheng District, Datong, 037006, Shanxi, China
| | - Z Wang
- Department of Orthopedics Surgery, Tianjin Medical University General Hospital, Tianjin, 300052, China
- Key Laboratory of Spine and Spinal Cord, Tianjin Medical University General Hospital, Tianjin, 300052, China
| | - Z Zhao
- Department of Orthopedics Surgery, Tianjin Medical University General Hospital, Tianjin, 300052, China
- Key Laboratory of Spine and Spinal Cord, Tianjin Medical University General Hospital, Tianjin, 300052, China
- Department of Orthopedics Surgery, Tianjin Fourth Centre Hospital, Tianjin, 300140, China
| | - Y Wang
- Department of Orthopedics Surgery, Tianjin Medical University General Hospital, Tianjin, 300052, China
- Key Laboratory of Spine and Spinal Cord, Tianjin Medical University General Hospital, Tianjin, 300052, China
- Department of Orthopedics Surgery, The Second Hospital of Tianjin Medical University, Tianjin, 300211, China
| | - Y Jiang
- Department of Medical Image Center, Tianjin Medical University General Hospital, Tianjin, 300052, China
| | - Y Xue
- Department of Orthopedics Surgery, Tianjin Medical University General Hospital, Tianjin, 300052, China.
- Key Laboratory of Spine and Spinal Cord, Tianjin Medical University General Hospital, Tianjin, 300052, China.
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6
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Gou PG, Zhao ZH, Zhou JM, Ren LH, Wang XY, Mu YF, Wang YG, Chang F, Xue Y. Vertebral Collapse Prevented Following Teriparatide Treatment in Postmenopausal Kümmell's Disease Patients with Severe Osteoporosis. Orthop Surg 2021; 13:506-516. [PMID: 33615746 PMCID: PMC7957397 DOI: 10.1111/os.12959] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 01/21/2021] [Accepted: 01/21/2021] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE To compare the preventive effects of teriparatide and alendronate on the progression of vertebral body collapse in postmenopausal single-level Kümmell's disease (KD). METHODS From March 2013 to December 2020, the medical records for 53 postmenopausal single-level KD patients who received conservative treatment with teriparatide (25 patients, teriparatide group) or alendronate (28 patients, alendronate group) were retrospectively reviewed. Midsagittal computed tomography (CT) images were analyzed by ImageJ to assess the intravertebral bone formation (mineralized bone) by calculating the ratio of area of intravertebral mineralized bone (AIMB) to the area of fractured vertebral body (AFVB). The changes in radiological parameters of the fractured vertebral body including kyphosis angle (KA), anterior and posterior border heights (ABH and PBH) and spinal canal diameter (SCD), bone turnover biomarkers (BTMs), and bone mineral density (BMD) were analyzed to evaluate the therapeutic effect. RESULTS At month 12, the ratio of AIMB to AFVB was significantly greater in teriparatide group (54.28% ± 15.30%) than in alendronate group (35.57% ± 17.61%) (P < 0.001). Sagittal CT substantiated the formation of bone bridge in 16 patients in teriparatide group. No bone bridge was detected in alendronate group. The KA was significantly smaller and the ABH, PBH, and SCD was greater in teriparatide group than in alendronate group (all P < 0.001). The KA increments were significantly smaller in teriparatide group (3.98° ± 1.30°) than in alendronate group (11.43° ± 3.73°) (P < 0.001). The ABH and PBH decrement were significantly lower in teriparatide group (11.96% ± 1.93% and 2.80% ± 2.52%) than in alendronate group (37.04% ± 8.00% and 19.50% ± 8.22%) (both P < 0.001). The BTMs and BMD were significantly greater in the teriparatide group than in the alendronate group. In teriparatide group, KA increment was negatively correlated with the change in PINP (r = -0.781, P < 0.001) and the ratio of AIMB to AFVB (r = -0.592, P = 0.002) from baseline to month 12. The ABH decrement was negatively correlated with the change in PINP (r = -0.612, P = 0.001) and the ratio of AIMB to AFVB (r = -0.806, P < 0.001) from baseline to month 12. CONCLUSIONS In postmenopausal single-level KD patients, conservative treatment with teriparatide was better than alendronate at preventing the progressive vertebral collapse.
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Affiliation(s)
- Peng-Guo Gou
- Department of Orthopaedic Surgery, Tianjin Medical University General Hospital, Tianjin, China.,Key Laboratory of Spine and Spinal Cord, Tianjin Medical University General Hospital, Tianjin, China.,Department of Orthopaedic Surgery, The Fifth People's Hospital of Datong, Datong, China
| | - Zhi-Hui Zhao
- Department of Orthopaedic Surgery, Tianjin Medical University General Hospital, Tianjin, China.,Key Laboratory of Spine and Spinal Cord, Tianjin Medical University General Hospital, Tianjin, China.,Department of Orthopaedic Surgery, The Fourth Central Clinical College, Tianjin Medical University, Tianjin, China
| | - Jia-Ming Zhou
- Department of Orthopaedic Surgery, Tianjin Medical University General Hospital, Tianjin, China.,Key Laboratory of Spine and Spinal Cord, Tianjin Medical University General Hospital, Tianjin, China
| | - Lin-Hui Ren
- Department of Orthopaedic Surgery, The Fourth Central Clinical College, Tianjin Medical University, Tianjin, China
| | - Xiao-Yun Wang
- Department of Orthopaedic Surgery, The Fifth People's Hospital of Datong, Datong, China
| | - Yu-Feng Mu
- Department of Orthopaedic Surgery, The Fifth People's Hospital of Datong, Datong, China
| | - Yun-Guo Wang
- Department of Orthopaedic Surgery, Tianjin Medical University General Hospital, Tianjin, China.,Key Laboratory of Spine and Spinal Cord, Tianjin Medical University General Hospital, Tianjin, China.,Department of Orthopaedic Surgery, The Second Hospital of Tianjin Medical University, Tianjin, China
| | - Feng Chang
- Department of Orthopaedic Surgery, The Affiliated People's Hospital of Shanxi Medical University, Taiyuan, China
| | - Yuan Xue
- Department of Orthopaedic Surgery, Tianjin Medical University General Hospital, Tianjin, China.,Key Laboratory of Spine and Spinal Cord, Tianjin Medical University General Hospital, Tianjin, China
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7
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Kong M, Zhou C, Ma X. The Application of Vertebral Augmentation Procedures and Teriparatide in the Treatment of Osteoporotic Vertebral Compression Fractures [Response to Letter]. Clin Interv Aging 2020; 15:83-85. [PMID: 32021136 PMCID: PMC6983463 DOI: 10.2147/cia.s242837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2019] [Indexed: 11/23/2022] Open
Affiliation(s)
- Meng Kong
- Department of Spinal Surgery, Affiliated Hospital of Qingdao University, Qingdao, Shandong Province 266000, People's Republic of China
| | - Chuanli Zhou
- Department of Spinal Surgery, Affiliated Hospital of Qingdao University, Qingdao, Shandong Province 266000, People's Republic of China
| | - Xuexiao Ma
- Department of Spinal Surgery, Affiliated Hospital of Qingdao University, Qingdao, Shandong Province 266000, People's Republic of China
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8
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Ma Y, Wu X, Xiao X, Ma Y, Feng L, Yan W, Chen J, Yang D. Effects of teriparatide versus percutaneous vertebroplasty on pain relief, quality of life and cost-effectiveness in postmenopausal females with acute osteoporotic vertebral compression fracture: A prospective cohort study. Bone 2020; 131:115154. [PMID: 31733423 DOI: 10.1016/j.bone.2019.115154] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 11/12/2019] [Accepted: 11/12/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND Osteoporotic vertebral compression fracture (OVCF) is a common disease in senior patients. Conservative treatments (usual care) and percutaneous vertebroplasty (PVP) are typically applied to treat OVCFs; however, their efficacies are not fully satisfactory. While Teriparatide (TPTD) is effective in both anti-osteoporosis and bone healing, whether TPTD could be applied as a conservative treatment for acute OVCFs remains unclear. METHODS This investigation represents a real-world prospective cohort study, where 60 postmenopausal women (≥55 years old) with acute OVCFs were equally assigned to a TPTD conservative group or PVP (plus alendronate) group based on the patient's choice. TPTD (20 μg, s.c., once daily) or alendronate (70 mg, p.o., once weekly) were administrated together with 0.6 mg Caltrate and 500 iu Vitamin D3 per day. A health survey (SF-36) was conducted at 0-, 1- and 3-months post-treatment. Back pain and the Oswestry Disability Index (ODI) were measured at 0-week, 1-week, 1-month and 3-months after treatment, while the direct medical cost was analyzed at the end of the third month. RESULTS Both treatments with TPTD and PVP significantly and similarly improved the patients' health quality, with reduced visual analogue and ODI scores at the end of the first and third months. PVP was more effective in reducing pain at the early time point (1 week, p < 0.05). 24 of 27 patients who were rescanned with magnetic resonance imaging in the TPTD group showed bone healing. The mid-vertebral height was increased by PVP (p < 0.05) but not by TPTD. The cost of TPTD treatment was 21,868.61 ± 167.05 RMB per capita, while the cost for PVP treatment was 33,265.95 ± 1491.11 RMB per capita (p < 0.05). CONCLUSION TPTD conservative treatment obtained similar therapeutic effects but cost less than PVP in terms of treating acute OVCF.
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Affiliation(s)
- Yangyang Ma
- Department of Spine Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Xiaoliang Wu
- Department of Spine Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Xiao Xiao
- Department of Spine Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Yao Ma
- Department of Spine Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Lan Feng
- Department of Spine Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Wenjuan Yan
- Department of Conservative and Endodontic Dentistry, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Jianting Chen
- Department of Spine Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Dehong Yang
- Department of Spine Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, China.
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9
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Zhou J, Xue Y. Could Teriparatide Replace Percutaneous Vertebral Augmentation for Patients with Osteoporotic Vertebral Compression Fracture to Some Extent? [Letter]. Clin Interv Aging 2019; 14:2095-2096. [PMID: 31819390 PMCID: PMC6897261 DOI: 10.2147/cia.s234553] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 11/25/2019] [Indexed: 11/23/2022] Open
Affiliation(s)
- Jiaming Zhou
- Department of Orthopaedic Surgery, Tianjin Medical University General Hospital, Tianjin, People's Republic of China
| | - Yuan Xue
- Department of Orthopaedic Surgery, Tianjin Medical University General Hospital, Tianjin, People's Republic of China
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10
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Abstract
Since FDA approval in 2002, teriparatide has gained popularity as an anabolic therapy for the treatment of osteoporosis. Animal studies have suggested a role for teriparatide in spine surgery. Several recent studies have demonstrated adjunctive use of teriparatide in osteoporotic patients undergoing spine fusions improves fusion rates, decreases time to union, and decreases osteoporosis-related complications such as proximal junctional kyphosis. On the basis of the available literature, we outline an algorithm for the use of teriparatide in spine surgery.
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11
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Tang Y, Xia H, Kang L, Sun Q, Su Z, Hao C, Xue Y. Effects of Intermittent Parathyroid Hormone 1-34 Administration on Circulating Mesenchymal Stem Cells in Postmenopausal Osteoporotic Women. Med Sci Monit 2019; 25:259-268. [PMID: 30620727 PMCID: PMC6330838 DOI: 10.12659/msm.913752] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Intermittent parathyroid hormone (PTH) 1-34 administration stimulates osteogenesis and increases bone marrow mesenchymal stem cell (MSC) density; however, its effect on the circulating MSCs is unknown. This study aimed to examine the effect of intermittent PTH 1-34 administration on circulating MSCs in the peripheral blood of postmenopausal osteoporotic women. MATERIAL AND METHODS Fifty-four postmenopausal osteoporotic women at high risk of fracture were enrolled and administered either teriparatide (PTH 1-34) or alendronate for 12 months. Whole blood samples were obtained at baseline, 1, 3, 6, and 12 months after initiation of treatment. Flow cytometry analyses were performed to identify circulating MSCs (CD73+, CD90+, CD105+, CD34-, and CD45-). Serum markers of bone formation, bone resorption, as well as bone mineral density (BMD) were serially measured. Circulating MSCs were isolated from peripheral blood of teriparatide treated women and cultured in osteogenic medium to examine their osteogenic differentiation potential. RESULTS Teriparatide treatment increased circulating MSCs to 141±96% (P<0.001) by month 1, persisting until month 12; this increase was positively associated with increases in bone formation and bone resorption biomarkers (at month 6) and spine BMD (at month 12). Furthermore, intermittent PTH 1-34 administration promoted in vitro osteogenic differentiation of circulating MSCs, evident from increased alkaline phosphatase (ALP) activity, ALP-expressing cell density, calcium deposition, and Runx-2, OSX, COL 1a1, and osteocalcin mRNA upregulation. CONCLUSIONS Intermittent PTH 1-34 administration increased circulating MSC density in women with postmenopausal osteoporosis and enhanced in vitro osteogenic differentiation potential of these cells.
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Affiliation(s)
- Yutao Tang
- Department of Orthopaedic Surgery, Tianjin Medical University General Hospital, Tianjin, China (mainland)
| | - Han Xia
- Department of Orthopaedic Surgery, Tianjin Medical University General Hospital, Tianjin, China (mainland)
| | - Liang Kang
- Department of Orthopaedic Surgery, Tianjin Medical University General Hospital, Tianjin, China (mainland)
| | - Quan Sun
- Department of Orthopaedic Surgery, Tianjin Medical University General Hospital, Tianjin, China (mainland)
| | - Zhe Su
- Department of Orthopaedic Surgery, Tianjin Medical University General Hospital, Tianjin, China (mainland)
| | - Congqiang Hao
- Department of Orthopaedic Surgery, Tianjin Medical University General Hospital, Tianjin, China (mainland)
| | - Yuan Xue
- Department of Orthopaedic Surgery, Tianjin Medical University General Hospital, Tianjin, China (mainland)
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Li W, Yuan L, Tong G, He Y, Meng Y, Hao S, Chen J, Guo J, Bringhurst R, Yang D. Phospholipase C signaling activated by parathyroid hormone mediates the rapid osteoclastogenesis in the fracture healing of orchiectomized mice. BMC Musculoskelet Disord 2018; 19:311. [PMID: 30157832 PMCID: PMC6116492 DOI: 10.1186/s12891-018-2231-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 08/14/2018] [Indexed: 12/31/2022] Open
Abstract
Background The age-related osteoporosis is an increasing risk severely threatening the live quality of aged people. Human parathyroid hormone (hPTH) is applied to the therapy of osteoporosis successfully, however, the mechanism, especially the signaling pathway activated in the healing fracture by PTH is still unknown. Methods The once daily injections of hPTH(1–34) and GR (1–34) (the PLC deficient analog) into the orchiectomized male mice with bone fracture, were started at the second day after fracture and lasted for 4 weeks. To explore the role of phospholipase C signaling in the androgen-deficient fracture healing, the fracture healing were evaluated via radiography, micro-CT, biomechanics testing, serum biochemistry, bone marrow cell culture and gene expression quantification. Results After two weeks of fracture, both peptides significantly increased bone mineral density (BMD), bone mass content (BMC) and bone volume (BV/TV) in the healing area. However, compared to hPTH(1–34), GR(1–34) induced more woven bones, the higher BMC and BMD, as well as the less serum TRAP and osteoclasts. After four weeks of treatment, the effects of hPTH(1–34) on fracture healing showed no difference to those of GR(1–34). Consistently, GR(1–34) induced the similar osteogenesis but less osteoclastogenesis under the ex vivo condition immediately after administration compared to hPTH(1–34), which was verified by the weaker activation of RANKL, NFATC1, TRAP and Cathepsin K in GR(1–34) treatment. Conclusion These results indicated that the PLC signaling activated by the intermittent injection of hPTH(1–34) leads to the bone resorption by rapidly activating the osteoclastogenesis in the fracture healing zone. Electronic supplementary material The online version of this article (10.1186/s12891-018-2231-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Wei Li
- Department of Spinal Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Liang Yuan
- Department of Spinal Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Guojun Tong
- Department of Spinal Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Youhua He
- Department of Spinal Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Yue Meng
- Department of Spinal Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Song Hao
- Department of Spinal Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Jianting Chen
- Department of Spinal Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Jun Guo
- Endocrine Unit, Massachusetts General Hospital, Boston, MA, 02114, USA
| | | | - Dehong Yang
- Department of Spinal Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China.
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Garg B, Dixit V, Batra S, Malhotra R, Sharan A. Non-surgical management of acute osteoporotic vertebral compression fracture: A review. J Clin Orthop Trauma 2017; 8:131-138. [PMID: 28720988 PMCID: PMC5498748 DOI: 10.1016/j.jcot.2017.02.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Revised: 01/20/2017] [Accepted: 02/02/2017] [Indexed: 02/08/2023] Open
Abstract
Osteoporosis is a major public health problem. Last decade has seen rise in osteoporotic vertebral fractures. Pragmatic management of osteoporotic VCF is challenging to the surgeons. In clinical settings, the situation becomes more complex when it comes to managing painful osteoporotic vertebral compression fractures (VCFs) due to various co-morbid factors that may limit aggressive interventions. Patients with Osteoporotic vertebral fractures are often characterized by general/relative immobility and physical frailty. Osteoporotic VCF not only affects the quality of life (e.g. pain) but also decreases the lifespan of the individual. The present review critically evaluates the currently prevailing non-surgical management modalities (conservative) offered in acute symptomatic osteoporotic VCFs that occur either within (0-5 days) of any incident event or present with the onset of symptoms such as pain.
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Affiliation(s)
- Bhavuk Garg
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
| | - Vivek Dixit
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
| | - Sahil Batra
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
| | - Rajesh Malhotra
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
| | - Alok Sharan
- WESTMED Spine Centre, New York, NY, United States
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