Role of Weekly Teriparatide Administration in Osseous Union Enhancement within Six Months After Posterior or Transforaminal Lumbar Interbody Fusion for Osteoporosis-Associated Lumbar Degenerative Disorders: A Multicenter, Prospective Randomized Study.

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Study Review

With the aging or a population, there has been significant increases in the number of patients receiving lumbar fusion operations secondary to spinal stenosis or spondylolisthesis with spinal stenosis.  Unfortunately, bone quality has bearing on the success  of lumbar fusions.  This paper is a 6 month randomized prospective study on the use of weekly subcutaneous teriparatide  on patients who underwent lumbar interbody spinal fusion for lumbar disc degenerative conditions.   The control group did not receive any teriparatide,  but both study groups receive daily calcium supplementation as well as used a lumbar corset for 3 months.

Radiologists were blinded to the treatment groups.  X-rays and CT scans were obtained postoperatively at 2 months, 4 months, and 6 months. A bone fusion scoring system was utilized.

Both groups had similar clinical outcomes, however,  In regards to the 6 month post procedure bone fusion score,  there is a statistical improvement for the teriparatide cohort.

The authors acknowledge the small sample size, limited follow-up, and the cost differential of the use of teriparatide.

The study however did identify a statistically significant, improvement of fusions rates during the 6 month followup.  As the author suggested, longer follow-ups, and a larger randomized control study may provide meaningful information on the use of teriparatide for osteoporotic patients undergoing spinal fusion surgery.

Currently, teriparatide is used as a tertiary measured to improve bone quality in patients with severe osteoporosis, but at least in the United States, a daily subcutaneous dose is the usual regimen.  Weekly dosing may have benefits as well as cost advantages compared to the daily dosing.  Future studies need to study efficacy as well as potential complication rate associated with a weekly dosing of teriparatide.

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