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Chen PA, Chiu PY, Kao FC, Hsieh MK, Tsai TT, Lai PL, Fu TS, Niu CC. Teriparatide alone versus vertebroplasty on pain control and radiographic outcomes after osteoporotic vertebral compression fracture. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:3284-3290. [PMID: 38937348 DOI: 10.1007/s00586-024-08349-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 03/14/2024] [Accepted: 05/27/2024] [Indexed: 06/29/2024]
Abstract
PURPOSE To investigate efficacy of 3-month teriparatide(TPD) and compare this treatment with vertebroplasty in terms of clinical and radiographic outcomes after osteoporotic vertebral compression fractures (OVCFs). METHODS This is a retrospective matched cohort study. Patients who received conservative treatment with at least 3-month TPD treatment for acute OVCF with at least 6 months follow-up were included. Each enrolled TPD case was matched with 2 vertebroplasty cases using age and gender. 30 TPD cases and 60 vertebroplasty cases were enrolled. Patient-reported pain scores were obtained at diagnosis and 1, 3, 6 months after diagnosis. Radiographic parameters including middle body height, posterior body height, wedge angle and kyphotic angle were measured at diagnosis and 6 months after diagnosis. Fracture non-union and subsequent vertebral fracture were evaluated. RESULTS TPD treatment showed inferior pain relief to vertebroplasty group at 1 month, but did not show difference at 3 and 6 months after diagnosis. In TPD cases, progression of vertebral body collapse was noted in terms of middle body height and wedge angle at final follow up. Instead, both middle body height and wedge angle increased significantly after operation in the vertebroplasty group. Fracture non-union was confirmed via MRI and 4 TPD patients were diagnosed with non-union (4/30, 13.3%). Subsequent compression fracture within 6 months was significant higher in vertebroplasty group (12/60, 20%) than in TPD group (1/30, 3.3%). CONCLUSION In acute OVCFs, 3-month TPD treatment alone showed comparable pain improvement and less subsequent spine fracture than vertebroplasty.
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Affiliation(s)
- Po-An Chen
- Department of Orthopedic Surgery, Spine Section, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Ping-Yeh Chiu
- Department of Orthopedic Surgery, Spine Section, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Fu-Cheng Kao
- Department of Orthopedic Surgery, Spine Section, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Ming-Kai Hsieh
- Department of Orthopedic Surgery, Spine Section, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Tsung-Ting Tsai
- Department of Orthopedic Surgery, Spine Section, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Po-Liang Lai
- Department of Orthopedic Surgery, Spine Section, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Tsai-Sheng Fu
- Department of Orthopedic Surgery, Spine Section, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chi-Chien Niu
- Department of Orthopedic Surgery, Spine Section, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
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Yang YC, Hsieh MH, Chien JT, Liu KC, Yang CC. Teriparatide treatment shows faster healing than sacroplasty for postmenopausal women with sacral insufficiency fracture. Osteoporos Sarcopenia 2023; 9:27-31. [PMID: 37082353 PMCID: PMC10111959 DOI: 10.1016/j.afos.2023.02.001] [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: 12/03/2022] [Revised: 01/06/2023] [Accepted: 02/03/2023] [Indexed: 04/22/2023] Open
Abstract
Objectives Sacral insufficiency fracture (SIF) is not an uncommon osteoporosis fracture among the elderly. Aside from traditional treatments, sacroplasty and teriparatide (TPTD) injection have been introduced. This report aims to compare the effects of sacroplasty and teriparatide on clinical outcomes of SIF. Methods Thirty-one elderly patients with SIF were enrolled in this retrospective observational study. Four male patients were excluded. Fourteen patients who received TPTD for 6 months were classified into the TPTD group (TT), and 13 who underwent sacroplasty were classified into the sacroplasty group (SS). All patients in both groups were instructed to take calcium and vitamin D supplements daily. Their symptoms and signs, visual analog score (VAS), Oswestry disability index (ODI), and radiographic studies were retrospectively reviewed. Results The TT group showed significantly lower VAS than SS group after 3 (P < 0.001) and 6 months of treatment (P < 0.001). The TT group also has significant lower ODI than SS group after 1 (P = 0.010), 3 (P = 0.005) and 6 months (P < 0.001) of treatment. Upon generalized estimating equations (GEE) analysis, the TT group showed significantly more reduction in both VAS and ODI compared to the SS group at 1 month (P = 0.022, P = 0.001), 3 months (P < 0.001, P < 0.001), and 6 months (P < 0.001, P < 0.001) post-treatment. Conclusions Postmenoposal woman with SIF who received TPTD healed better than those who underwent sacroplasty after 1 month treatment.
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Affiliation(s)
- Yao-Chun Yang
- National Taiwan University, School of Medicine, Taiwan
| | - Min-Hong Hsieh
- Department of Orthopedics, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, 62247, Taiwan
- School of Medicine, Tzu Chi University, 97071, Taiwan
| | - Jui-Teng Chien
- Department of Orthopedics, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, 62247, Taiwan
- School of Medicine, Tzu Chi University, 97071, Taiwan
| | - Keng-Chang Liu
- Department of Orthopedics, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, 62247, Taiwan
| | - Chang-Chen Yang
- Department of Orthopedics, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, 62247, Taiwan
- School of Medicine, Tzu Chi University, 97071, Taiwan
- Corresponding author. Department of Orthopedics, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 2, Minsheng Rd., Dalin Township, Chiayi County, 62247, Taiwan.
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PG G, Chugh A, Chaudhry K, Kaur A, Kumar P, Gaur S, Kumar S, Singh S. Comparison of Teriparatide and Combination of Cissus Quadrangularis and Dalbergia Sissoo on Bone Healing Against the Control Group in Maxillofacial Fractures: A Randomized Open-label Control Trial. Craniomaxillofac Trauma Reconstr 2023; 16:23-33. [PMID: 36824186 PMCID: PMC9941294 DOI: 10.1177/19433875211067007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Study Design Randomized Control Trial. Objective A randomized control trial was planned to aim to assess whether subcutaneous Injection of Teriparatide and Tablet Reunion (combination of Cissus Quadrangularis and Dalbergia sissoo) improves maxillofacial fracture healing as compared to the control group. Methods 24 patients of mandibular fracture with or without concomitant maxillofacial fractures were randomly divided into 3 equal groups (Group 1- Control, Group 2- Tablet Reunion, and Group 3- Injection Teriparatide) and the treatment duration was 4 weeks. Pain, fracture site mobility, bite force, serum markers, and radiographic healing were assessed preoperatively and postoperatively at regular intervals till 12 weeks. Results Group 2 showed early pain relief, although it was insignificant. Group 3 showed the highest anterior bite force at all the time points. Change in mean posterior bite force (PBF) showed a statistically significant increase at 8th week and 12th week in intergroup comparison; however, at 12th week, Group 3 was significantly better than Group 1 and reported the highest posterior bite force compared to other groups. Serum calcium and PTH level showed no significant difference, whereas Serum ALP showed a statistically significant increase in Group 3. The radiographic assessment showed no significant difference among the 3 groups. Conclusions Both the intervention group drugs showed a promising effect on accelerating the fracture healing and improving bite force restoration with the osteoanabolic action; however, early radiographic healing and increased serum osteogenic markers in Group 3 indicate its possible optimistic role in maxillofacial fracture healing.
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Affiliation(s)
- Gigi PG
- Department of Dentistry, All India Institute of Medical Sciences Jodhpur, Jodhpur, India
| | - Ankita Chugh
- Department of Dentistry, All India Institute of Medical Sciences Jodhpur, Jodhpur, India
| | - Kirti Chaudhry
- Department of Dentistry, All India Institute of Medical Sciences Jodhpur, Jodhpur, India
| | - Amanjot Kaur
- Department of Dentistry, All India Institute of Medical Sciences Jodhpur, Jodhpur, India
| | - Pravin Kumar
- Department of Dentistry, All India Institute of Medical Sciences Jodhpur, Jodhpur, India
| | - Shubham Gaur
- Department of Dentistry, All India Institute of Medical Sciences Jodhpur, Jodhpur, India
| | - Shailendra Kumar
- Department of Dentistry, All India Institute of Medical Sciences Jodhpur, Jodhpur, India
| | - Surjit Singh
- Department of Dentistry, All India Institute of Medical Sciences Jodhpur, Jodhpur, India
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Kobayashi T, Akiyama T, Morimoto T, Hotta K, Mawatari M. A systematic review regarding clinical characteristics, complications, and outcomes of surgical and non-surgical patients with fragility fracture of the pelvis. NAGOYA JOURNAL OF MEDICAL SCIENCE 2023; 85:35-49. [PMID: 36923634 PMCID: PMC10009624 DOI: 10.18999/nagjms.85.1.35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 03/30/2022] [Indexed: 03/18/2023]
Abstract
We conducted this systematic review to clarify the clinical characteristics, complications, and outcomes of surgical and non-surgical patients with fragility fracture of the pelvis (FFP). We searched PubMed, Google Scholar, Cochrane Library, Web of Science, and MEDLINE for English language articles on FFP. We calculated pooled odds ratios (ORs) or mean differences (MDs) of surgical patients in comparison to non-surgical patients for clinical characteristics (Rommens FFP classification, age, sex, dementia, osteoporosis, diabetes mellitus, pulmonary disease, cardiovascular disease, and malignancy), complications (pneumonia, urinary tract infection, cardiac event, thrombosis, pulmonary embolism, pressure ulcer, multiple organ failure, anemia caused by surgical bleeding, and surgical site infection), and outcomes (hospital mortality and one-year mortality). Five studies involving 1,090 patients with FFP (surgical patients, n = 432; non-surgical patients, n = 658) were included. FFP type III and IV (OR = 8.44; 95% confidence interval [CI] 5.99 to 11.88; p<0.00001), a younger age (MD = -3.29; 95% CI -3.83 to -2.75; p<0.00001), the absence of dementia (OR = 0.36; 95% CI 0.23 to 0.57; p<0.0001), and the presence of osteoporosis (OR = 1.74; 95% CI 1.29 to 2.35; p = 0.0003) were significantly associated with the surgical patients. Urinary tract infection (OR = 2.06; 95% CI 1.37 to 3.10; p = 0.0005), anemia caused by surgical bleeding (OR = 4.55; 95% CI 1.95 to 10.62; p = 0.0005), and surgical site infection (OR = 16.74; 95% CI 3.05 to 91.87; p = 0.001) were significantly associated with the surgical patients. There were no significant differences in the outcomes between the surgical and non-surgical patients. Our findings may help to further understand the treatment strategy for FFP and improve clinical outcomes.
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Affiliation(s)
- Takaomi Kobayashi
- Department of Orthopaedic Surgery, Imari-Arita Kyoritsu Hospital, Arita , Japan.,Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Takayuki Akiyama
- Department of Orthopaedic Surgery, Imari-Arita Kyoritsu Hospital, Arita , Japan.,Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Tadatsugu Morimoto
- Department of Orthopaedic Surgery, Imari-Arita Kyoritsu Hospital, Arita , Japan.,Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Kensuke Hotta
- Department of Orthopaedic Surgery, Amagi Chuo Hospital, Asakura, Japan
| | - Masaaki Mawatari
- Department of Orthopaedic Surgery, Imari-Arita Kyoritsu Hospital, Arita , Japan.,Department of Orthopaedic Surgery, Faculty of Medicine, Saga University, Saga, Japan
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Gamada H, Yanagisawa Y, Teruya S, Eda Y, Nakagawa T, Yamazaki M. Clinical Outcome of Sacroiliac Rod Fixation for Fragility Fracture of the Pelvis Rommens and Hoffman Classification Type IVb: Case Series. Geriatr Orthop Surg Rehabil 2022; 13:21514593221141358. [DOI: 10.1177/21514593221141358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 11/07/2022] [Indexed: 11/21/2022] Open
Abstract
Introduction Fragility fracture of the pelvis (FFP), generally involving Rommens and Hoffman classification type IVb (H-shaped) requires spinopelvic fixation (SPF). We report the clinical outcome of sacroiliac rod fixation (SIRF) for FFP type IVb in a case series. Materials and Methods In this retrospective observational study, six patients (mean age, 80.3 years; range, 74-85 years) with FFP type IVb who underwent SIRF since October 2019 and could be followed up for ≥1 year postoperatively were included. All patients were injured in low-energy falls, a patient had a femoral neck fracture, and other had a humeral neck fracture and distal radius fracture. Results The mean (range) operative time was 135 (98-200) min, and mean blood loss was 103 (80-130) g. All patients achieved bone union in an average of 4.3 months. No implant failure or surgical site infection requiring reoperation occurred. No patient complained of iliac screw irritation or requested removal. One patient developed a T12 vertebral fracture at 3 weeks postoperatively. The mean final follow-up period was 17.8 months (13-22 months) and mean final modified Majeed Score (maximum 76 points as the items “work” and “sexual intercourse” were omitted for this study) was 71.7 (56-76). Conclusions SIRF is a less invasive surgical technique than SPF that uses only an S1 pedicle screw and iliac screw. SIRF using the “within ring” concept showed good clinical outcome in FFP type IVb.
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Affiliation(s)
- Hisanori Gamada
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
- Department of Orthopaedic Surgery, Ibaraki Western Medical Center, Chikusei, Japan
| | - Yohei Yanagisawa
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Shotaro Teruya
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Yusuke Eda
- Department of Orthopaedic Surgery, Ibaraki Western Medical Center, Chikusei, Japan
| | - Tsukasa Nakagawa
- Department of Orthopaedic Surgery, Ibaraki Western Medical Center, Chikusei, Japan
| | - Masashi Yamazaki
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
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Rocha T, Cavalcanti AS, Leal AC, Dias RB, da Costa RS, Ribeiro GDO, Guimarães JAM, Duarte MEL. PTH 1-34 improves devitalized allogenic bone graft healing in a murine femoral critical size defect. Injury 2021; 52 Suppl 3:S3-S12. [PMID: 34088469 DOI: 10.1016/j.injury.2021.03.063] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 03/24/2021] [Accepted: 03/26/2021] [Indexed: 02/02/2023]
Abstract
The treatment of large segmental defects of long bones resulting from trauma, infection, or bone tumor resections is a major challenge for orthopedic surgeons. The reconstruction of bone defects with acellular allografts can be used as an osteoconductive approach. However, devitalized allografts are associated with high rates of clinical failure as a result of poor intrinsic osteoinduction properties and a lack of further remodeling. Nevertheless, evidence suggests that due to its anabolic properties, teriparatide (PTH1-34) could be effective as an adjuvant therapy for massive allograft healing. Therefore, our goal was to investigate in a murine critical-sized defect model whether the intermittent administration of PTH1-34 improves the incorporation and revitalization of acellular structural bone allografts. Thus, a 2.5-mm critical-sized defect was established in the right femur of C57BL/6 mice, followed by the reconstruction with a devitalized cortical structural allograft. A titanium micro locking plate was applied to the anterior femoral surface and secured in place with self-tapping locking screws. Subsequently, daily doses of PTH1-34 (30, and 40 µg/kg) or saline were administered to the mice for 14 days after surgery. The mice were maintained without PTH1-34 therapy for an additional 7 days before being euthanized at 3 weeks post-surgery. Bone graft consolidation was assessed on radiographic images and by histomorphometric analysis. Additionally, to determine the frequency of osteoprogenitor cells in the bone marrow and their in vitro osteogenic capacity, stromal cells were isolated from the bone marrow of animals treated with 30 or 40 µg/kg/day of PTH1-34 following the same protocol used for the experimental animals. Our results suggest that intermittent PTH1-34 treatment at 30 µg/kg/day after femoral allograft reconstruction surgery accelerated the healing process as evidenced by new bone formation induced on endosteal and periosteal surfaces, enhanced revitalization of allogeneic graft, and increased frequency and osteogenic capacity of bone marrow stromal cells (BMSC). These findings should encourage further studies aimed at investigating the potential therapeutic use of intermittent PTH1-34, specifically with regards to the optimal dosing regimen in clinically challenging orthopedic scenarios.
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Affiliation(s)
- Tito Rocha
- Trauma Center, National Institute of Traumatology and Orthopedics, Rio de Janeiro 20940-070, Brazil.
| | - Amanda S Cavalcanti
- Research Division, National Institute of Traumatology and Orthopedics, Rio de Janeiro 20940-070, Brazil.
| | - Ana Carolina Leal
- Research Division, National Institute of Traumatology and Orthopedics, Rio de Janeiro 20940-070, Brazil.
| | - Rhayra B Dias
- Research Division, National Institute of Traumatology and Orthopedics, Rio de Janeiro 20940-070, Brazil.
| | - Rafaela Sartore da Costa
- Research Division, National Institute of Traumatology and Orthopedics, Rio de Janeiro 20940-070, Brazil.
| | | | - João Antonio Matheus Guimarães
- Trauma Center, National Institute of Traumatology and Orthopedics, Rio de Janeiro 20940-070, Brazil; Research Division, National Institute of Traumatology and Orthopedics, Rio de Janeiro 20940-070, Brazil.
| | - Maria Eugênia Leite Duarte
- Research Division, National Institute of Traumatology and Orthopedics, Rio de Janeiro 20940-070, Brazil.
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Bovbjerg P, Høgh D, Froberg L, Schmal H, Kassem M. Effect of PTH treatment on bone healing in insufficiency fractures of the pelvis: a systematic review. EFORT Open Rev 2021; 6:9-14. [PMID: 33532082 PMCID: PMC7845562 DOI: 10.1302/2058-5241.6.200029] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
The aging of our society is associated with an increasing number of insufficiency fractures of the pelvis and the current standard of care is pain control and early mobilization. The aim of this study was to explore whether parathyroid hormone (PTH) treatment can support bone healing in these patients. We conducted a systematic review searching the databases PubMed, Embase and Cochrane. Our primary outcome was fracture healing, secondary outcome measures comprised pain, mobility and patient-reported outcome measures (PROMs). Eight articles were included in the qualitative synthesis, of which two were included in a meta-analysis. However, only three studies were comparative including one randomized controlled trial. Fracture healing and reported pain were assessed after eight weeks, and were significantly improved in the group being treated with PTH (p < 0.01) in the meta-analysis. All articles described a positive effect for PTH on fracture healing and pain. Our systematic review indicates that there is a positive effect of PTH treatment on healing and pain in patients with insufficiency fracture in the pelvic ring, but further research is necessary.
Cite this article: EFORT Open Rev 2021;6:9-14. DOI: 10.1302/2058-5241.6.200029
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Affiliation(s)
- Pernille Bovbjerg
- Department of Orthopedic Surgery, Odense University Hospital, Odense, Denmark
| | - Ditte Høgh
- Department of Orthopedic Surgery, Hospital of Southern Denmark, Odense, Denmark
| | - Lonnie Froberg
- Department of Orthopedic Surgery, Odense University Hospital, Odense, Denmark
| | - Hagen Schmal
- Department of Orthopedic Surgery, Odense University Hospital, Odense, Denmark.,Clinic of Orthopaedic Surgery, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Moustapha Kassem
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
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Zhang J, Yan B, Chen Z, Zheng Z, Yang C. Risk of New Vertebral Fracture and Combination Therapy with Zoledronic Acid and Teriparatide in Diabetic Patients after Percutaneous Kyphoplasty. Asian Spine J 2020; 15:611-617. [PMID: 33189105 PMCID: PMC8561158 DOI: 10.31616/asj.2020.0282] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 07/29/2020] [Indexed: 01/08/2023] Open
Abstract
Study Design This was a retrospective clinical study. Purpose This study aimed to evaluate the effect of combination therapy with zoledronic acid and teriparatide on the risk of new vertebral fracture (NVF) in type 2 diabetes mellitus (T2DM) patients after percutaneous kyphoplasty (PKP). Overview of Literature Although T2DM had been associated with bone fragility and increased fracture risk, it remains unknown whether patients with T2DM could expect similar benefit from the combination therapy with zoledronic acid and teriparatide following PKP. Methods Total 106 diabetic patients who had undergone PKP and had received anti-osteoporosis treatment for osteoporotic vertebral compression fracture were enrolled and allocated into the following two groups: group I (n=52, zoledronic acid) and group II (n=54, zoledronic acid plus teriparatide). The operating time, bone cement volume, and complications related to anti-osteoporosis treatment or PKP, if any, were recorded. The Visual Analog Scale (VAS) score and Oswestry Disability Index (ODI) were assessed at admission, at discharge, and at the final follow-up. Dual-energy X-ray absorptiometry scan of the hip for the measurement of the bone mineral density (BMD) was performed preoperatively and at the final follow-up for all the patients. Results There was no significant difference in the age, body mass index, bone cement volume, or follow-up time of the groups. The mean follow-up duration was 22.5±1.6 months. All the patients had improved VAS and ODI, and group II had significantly better clinical outcomes than group I. All the patients had increased BMD at the latest follow-up, while group II exhibited significantly more improvement. The prevalence of NVF was lower in group II (11.5% vs. 7.4%, p=0.523). Male patients had a higher prevalence of NVF although the difference was not statistically significant. Conclusions Combination therapy with zoledronic acid and teriparatide could improve the clinical outcomes, and BMD and had the potential to reduce NVF in diabetic patients following PKP.
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Affiliation(s)
- Jian Zhang
- Department of Spine Surgery, Shenzhen Second People's Hospital, The 1st Affiliated Hospital of Shenzhen University, Shenzhen, People's Republic of China
| | - Bin Yan
- Department of Spine Surgery, Shenzhen Second People's Hospital, The 1st Affiliated Hospital of Shenzhen University, Shenzhen, People's Republic of China
| | - Zhe Chen
- Department of Traumatology and Orthopedics, Ruijin Hospital North, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
| | - Zhaomin Zheng
- Department of Spine Surgery, The 1st Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Changsheng Yang
- Department of Spine Surgery, The Third Affiliated Hospital of Southern Medical University, Guangzhou, People's Republic of China
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Yoon BH, Kim KC. Does Teriparatide Improve Fracture Union?: A Systematic Review. J Bone Metab 2020; 27:167-174. [PMID: 32911581 PMCID: PMC7571240 DOI: 10.11005/jbm.2020.27.3.167] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 08/26/2020] [Indexed: 01/10/2023] Open
Abstract
We conducted an updated review of the evidence of teriparatide (TPTD) for fracture healing for the following questions. (1) Does it decrease fracture healing time?; (2) Can it be an alternative treatment for nonunion?; (3) Does it aid the union of atypical femoral fracture (AFF)? We searched PubMed, EMBASE, and Cochrane Library including “Fracture” AND “nonunion” AND “Teriparatide”. In total, 57 publications met our inclusion criteria were summarized. This systemic review of the available literature revealed that TPTD works positively with regard to enhancing fracture healing time and union of AFF. There are also many case studies on the use of TPTD could be a potential new safe treatment for nonunion with no side effects. However, level 1 studies on the evidence of TPTD are still lacking so far. Over the last decade, a growing body of evidence has accumulated suggesting that TPTD can be an adjunct to enhance fracture healing or a therapeutic option to treat nonunion, but greater evidences from large volume prospective trials are needed.
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Affiliation(s)
- Byung-Ho Yoon
- Department of Orthopaedic Surgery, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Ki-Choul Kim
- Department of Orthopaedic Surgery, Dankook University Hospital, Dankook University College of Medicine, Cheonan, Korea
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Abstract
Sacral fractures are a heterogeneous group of fractures occurring in young people following road traffic accidents and falls from height, or in the elderly with osteoporosis following trivial trauma.This heterogeneity, combined with the low incidence of sacral fractures, determines a lack of experience amongst physicians, often leading to misdiagnosis, underestimation and inadequate treatment. The diagnosis should be made by assessing specific features during the clinical presentation, while computed tomography (CT) scan continues to be the choice of investigation.Sacral fractures can be treated non-operatively or surgically. Non-operative treatment is based on rest, pain relief therapy and early mobilization as tolerated. Surgical techniques can be split into two main groups: posterior pelvic fixation techniques and lumbopelvic fixation techniques. Anterior pelvic fixation techniques should be considered when sacral fractures are associated with anterior pelvic ring injuries, in order to increase stability and reduce the risk of posterior implant failure. To improve fracture reduction, different solutions could be adopted, including special positioning of the patient, manipulation techniques and use of specific reduction tools. Patients suffering from spinopelvic dissociation with associated neurologic lesions hardly ever recover completely, with residual lower-limb neurologic sequelae, urinary problems and sexual disfunction.Herein, we present issues, challenges and solutions related to the management of sacral fractures. Cite this article: EFORT Open Rev 2020;5:299-311. DOI: 10.1302/2058-5241.5.190064.
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Affiliation(s)
- Emmanuele Santolini
- Academic Unit of Trauma and Orthopaedics, University of Genoa, Italy.,Academic Department of Trauma and Orthopaedics, LGI, University of Leeds, UK
| | | | - Peter V Giannoudis
- Academic Department of Trauma and Orthopaedics, LGI, University of Leeds, UK.,NIHR Leeds Biomedical Research Center, Chapel Allerton Hospital, Leeds, UK
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11
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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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Kinoshita H, Miyakoshi N, Kobayashi T, Abe T, Kikuchi K, Shimada Y. Comparison of patients with diagnosed and suspected sacral insufficiency fractures. J Orthop Sci 2019; 24:702-707. [PMID: 30583938 DOI: 10.1016/j.jos.2018.12.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 11/27/2018] [Accepted: 12/05/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Patients with sacral insufficiency fractures can have a range of symptoms, and because these fractures are difficult to detect using plain radiographs, it can be tough to make a definitive diagnosis of fracture early after injury. The aim of this study was to compare the diagnosis and treatment of patients with known sacral insufficiency fractures to those with suspected insufficiency fractures to clarify the features of sacral insufficiency fractures. METHODS We compared patients with sacral insufficiency fractures (S group) to those with suspected insufficiency fractures (N group) using demographic data, symptoms, time to definitive diagnosis, radiological methods, and treatments. RESULTS Patients in the S group were older than those in the N group (p = 0.0042) and showed less localized sacral pain (p = 0.0042). Almost all of the patients in the S group (74%) required magnetic resonance imaging for definitive diagnosis. CONCLUSIONS Sacral insufficiency fractures should not be diagnosed based on the site of pain or using plain radiographs. Patient age and magnetic resonance imaging are more informative to obtain a definitive diagnosis of sacral insufficiency fractures.
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Affiliation(s)
- Hayato Kinoshita
- Akita Kosei Medical Center, Department of Orthopedic Surgery, 1-1-1 Nishibukuro Iijima Akita, Akita, 011-0948, Japan.
| | - Naohisa Miyakoshi
- Akita Graduate School of Medicine, Department of Orthopedic Surgery, 1-1-1 Hondo Akita, Akita, 010-8543, Japan
| | - Takashi Kobayashi
- Akita Kosei Medical Center, Department of Orthopedic Surgery, 1-1-1 Nishibukuro Iijima Akita, Akita, 011-0948, Japan
| | - Toshiki Abe
- Akita Kosei Medical Center, Department of Orthopedic Surgery, 1-1-1 Nishibukuro Iijima Akita, Akita, 011-0948, Japan
| | - Kazuma Kikuchi
- Akita Kosei Medical Center, Department of Orthopedic Surgery, 1-1-1 Nishibukuro Iijima Akita, Akita, 011-0948, Japan
| | - Yoichi Shimada
- Akita Graduate School of Medicine, Department of Orthopedic Surgery, 1-1-1 Hondo Akita, Akita, 010-8543, Japan
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Lumbopelvic Fixation for Sacral Insufficiency Fracture Presenting with Sphincter Dysfunction. Case Rep Orthop 2019; 2019:9097876. [PMID: 31093401 PMCID: PMC6476123 DOI: 10.1155/2019/9097876] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Revised: 03/05/2019] [Accepted: 03/25/2019] [Indexed: 11/17/2022] Open
Abstract
Sacral insufficiency fractures (SIFs) are common in the elderly. In patients with SIF, objective neurological abnormalities such as sphincter dysfunction or leg paresthesia are uncommon. We present a case of SIF accompanied by spinopelvic dissociation with late neurological compromise treated by spinopelvic fixation. A 61-year-old woman presented to our hospital with low back pain without obvious trauma history. She had a past history of eosinophilic granulomatosis with polyangiitis and treatment with steroids. Her low back pain became worse, and she started to have radiating left posterior thigh pain and motor weakness in the left ankle and both great toes with symptoms of stress urinary incontinence, constipation, and loss of anal sensation. Magnetic resonance imaging revealed an H-shaped sacrum fracture. We attributed the neurological symptoms to unstable SIF and performed lumbopelvic fixation. After the surgery, her leg pain and symptoms of stress urinary incontinence improved markedly, as did anal sensation. At a 6-month follow-up, the patient reported no low back pain and she was walking independently without pelvic complaints. CT showed bone union was achieved. Even minimally displaced SIF in patients with osteoporosis can be a cause of bowel and bladder disturbance. Lumbopelvic fixation is a treatment option for SIF with spinopelvic dissociation presenting neurological deficit.
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