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Comparative analysis of anti-osteoporosis medications in preventing vertebral body fractures after balloon kyphoplasty

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Abstract

Summary

This retrospective study compared the efficacy of anabolic agents (romosozumab and teriparatide) with that of alendronate in preventing subsequent vertebral body fractures (SVBFs) after balloon kyphoplasty (BKP). All anabolic agents significantly reduced SVBFs. Romosozumab was most effective in increasing bone mineral density (BMD) and completely suppressed distant vertebral body fractures.

Introduction

To determine optimal anti-osteoporosis medications, we compared romosozumab and teriparatide to alendronate as a control from perioperative BKP to the 1st postoperative year for treatment and secondary fracture prevention in osteoporosis.

Methods

A total of 603 patients who underwent initial BKP for osteoporotic vertebral fractures were evaluated and categorized into five groups based on drug administration: romosozumab (group R, 155 patients), twice-weekly teriparatide (group TW, 48), weekly teriparatide (group W, 151), daily teriparatide (group D, 138), and alendronate (control) (group C, 111). The 1-year incidence of SVBFs, BMD change rate, and probability of requiring BKP were compared among the groups.

Results

SVBF incidence was 3.9%, 6.5%, 8.3%, 6.0%, and 14.4% in groups R, D, TW, W, and C, respectively, with all other groups exhibiting significantly lower rates than group C. The groups that administered the anabolic agents had a notably lower incidence of distant fractures than group C. Compared with group C, group R showed significantly higher BMD change rates in lumbar vertebral bodies at 4, 8, and 12 months and group D at 12 months. Anabolic agent groups exhibited significantly higher improvement rates than group C after conservative treatment alone.

Conclusion

The anabolic agents were found to be more effective at reducing the incidence of SVBF (especially distant vertebral fractures) than alendronate. These agents decreased the rate of repeat BKP even after the occurrence of a fracture. Overall, the use of an anabolic agent for the treatment of osteoporosis after BKP is better than the use of alendronate, even when treatment is initiated in the perioperative stage.

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Data Availability

The data that support the findings of this study are available from the authors upon reasonable request. A written application stating the purpose of the data to be used must be submitted to the Ethics Committee of our hospital for permission. To maintain patient confidentiality, all data that enable identification of the patient will be deleted.

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Acknowledgements

We thank Yoshio Makino in the Information System Section of Machida Keisen Hospital for his great contribution to collecting information from the medical records of patients.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Machida Keisen Hospital, 2-1-47 Minamimachida, Machida, Tokyo, 194-0005, Japan

    Masaki Ueno, Yusuke Tajima, Shogo Ito & Masaki Tsuji

  2. Department of Rehabilitation, Machida Keisen Hospital, 2-1-47 Minamimachida, Machida, Tokyo, 194-0005, Japan

    Emi Toriumi, Aki Yoshii & Nanaka Otake

  3. Department of Radiology, Machida Keisen Hospital, 2-1-47 Minamimachida, Machida, Tokyo, 194-0005, Japan

    Hisashi Tanaka

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  1. Masaki Ueno
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Correspondence to Masaki Ueno.

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This single-center retrospective study was performed with the approval of the institutional review board of Machida Keisen Hospital (Approval Number: 2023–001).

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Ueno, M., Tajima, Y., Ito, S. et al. Comparative analysis of anti-osteoporosis medications in preventing vertebral body fractures after balloon kyphoplasty. Arch Osteoporos 19, 19 (2024). https://doi.org/10.1007/s11657-024-01374-7

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