Skip to main content

Advertisement

SpringerLink
Log in

Restoration of the intravertebral stability in Kümmell’s disease following the treatment of severe postmenopausal osteoporosis by 1-34PTH—a retrospective study

  • Original Article
  • Published:
Osteoporosis International Aims and scope Submit manuscript

Abstract

Summary

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Data availability

The authors declare the availability of data and material.

References

  1. Steel HH (1951) Kümmell's disease. Am J Surg 81(2):161–167

    Article  CAS  Google Scholar 

  2. Libicher M, Appelt A, Berger I, Baier M, Meeder P-J, Grafe I, DaFonseca K, Nöldge G, Kasperk C (2007) The intravertebral vacuum phenomen as specific sign of osteonecrosis in vertebral compression fractures: results from a radiological and histological study. Eur Radiol 17(9):2248–2252

    Article  Google Scholar 

  3. Lau E, Ong K, Kurtz S, Schmier J, Edidin A (2008) Mortality following the diagnosis of a vertebral compression fracture in the Medicare population. J Bone Joint Surg Am 90:1479–1486

    Article  Google Scholar 

  4. Tsoumakidou G, Too CW, Koch G, Caudrelier J, Cazzato RL, Garnon J, Gangi A (2017) CIRSE guidelines on percutaneous vertebral augmentation. Cardiovasc Intervent Radiol 40(3):331–342

    Article  Google Scholar 

  5. Rabei R, Patel K, Ginsburg M, Patel MV, Turba UC, Arslan B, Ahmed O (2019) Percutaneous vertebral augmentation for vertebral compression fractures: national trends in the medicare population (2005-2015). Spine 44(2):123–133

    Article  Google Scholar 

  6. Yang H, Pan J, Wang G (2014) A review of osteoporotic vertebral fracture nonunion management. Spine 39:B4–B6

    Article  Google Scholar 

  7. Y-x L, Guo D-q, S-c Z, Liang D, Yuan K, G-y M, D-x L, Guo H-z, Tang Y, Luo P-j (2018) Risk factor analysis for re-collapse of cemented vertebrae after percutaneous vertebroplasty (PVP) or percutaneous kyphoplasty (PKP). Int Orthop 42(9):2131–2139

    Article  Google Scholar 

  8. Heo DH, Chin DK, Yoon YS, Kuh SU (2009) Recollapse of previous vertebral compression fracture after percutaneous vertebroplasty. Osteoporos Int 20(3):473–480

    Article  CAS  Google Scholar 

  9. Mudano AS, Bian J, Cope JU, Curtis JR, Gross TP, Allison JJ, Kim Y, Briggs D, Melton ME, Xi J, Saag KG (2009) Vertebroplasty and kyphoplasty are associated with an increased risk of secondary vertebral compression fractures: a population-based cohort study. Osteoporos Int 20(5):819–826

    Article  CAS  Google Scholar 

  10. Morris O, Mathai J, Weller K (2019) Polymethylmethacrylate pulmonary embolism following kyphoplasty. Clin Pract Cases Emerg Med 3(3):226–228

    Article  Google Scholar 

  11. Morghen I, Borrelli M, Saletti A, Zoppellari R (2009) Percutaneous vertebroplasty and spinal cord compression: a case report. J Radiol Case Rep 3(3):17–20

    PubMed  PubMed Central  Google Scholar 

  12. Neer RM, Arnaud CD, Zanchetta JR, Pince R, Gaich GA, Reginster J-Y, Hodsman AB, Eriksen EF, Ish-Shalom S, Genant HK, Wang O, Mitlak BH (2001) Effect of parathyroid hormone (1-34) on fractures and bone mineral density in postmenopausal women with osteoporosis. N Engl J Med 344(19):1434–1441

    Article  CAS  Google Scholar 

  13. Min H-K, Ahn J-H, Ha K-Y, Kim Y-H, Kim S-I, Park H-Y, Rhyu K-W, Kim Y-Y, Oh I-S, Seo J-Y, Chang D-G, Cho J-H (2019) Effects of anti-osteoporosis medications on radiological and clinical results after acute osteoporotic spinal fractures: a retrospective analysis of prospectively designed study. Osteoporos Int 30(11):2249–2256

    Article  CAS  Google Scholar 

  14. Iwata A, Kanayama M, Oha F, Hashimoto T, Iwasaki N (2017) Effect of teriparatide (rh-PTH 1–34) versus bisphosphonate on the healing of osteoporotic vertebral compression fracture: a retrospective comparative study. BMC Musculoskelet Disord 18(1):148

    Article  Google Scholar 

  15. Zhao Y, Xue R, Shi N, Xue Y, Zong Y, Lin W, Pei B, Sun C, Fan R, Jiang Y (2016) Aggravation of spinal cord compromise following new osteoporotic vertebral compression fracture prevented by teriparatide in patients with surgical contraindications. Osteoporos Int 27(11):3309–3317

    Article  CAS  Google Scholar 

  16. Ha K, Park K, Kim S, Kim Y (2016) Does bisphosphonate-based anti-osteoporosis medication affect osteoporotic spinal fracture healing? Osteoporos Int 27(2):483–488. https://doi.org/10.1007/s00198-015-3243-6

    Article  CAS  PubMed  Google Scholar 

  17. Miller P (2016) Management of severe osteoporosis. Expert Opin Pharmacother 17:473–488

    Article  CAS  Google Scholar 

  18. Diamond T, Clark W, Kumar S (2007) Histomorphometric analysis of fracture healing cascade in acute osteoporotic vertebral body fractures. Bone 40:775–780

    Article  Google Scholar 

  19. Michalska D, Luchavova M, Zikan V, Raska I Jr, Kubena A, Stepan J (2012) Effects of morning vs. evening teriparatide injection on bone mineral density and bone turnover markers in postmenopausal osteoporosis. Osteoporos Int 23:2885–2891

    Article  CAS  Google Scholar 

  20. Scott P, Huskisson E (1977) Measurement of functional capacity with visual analogue scales. Rheumatol Rehabil 16(4):257–259. https://doi.org/10.1093/rheumatology/16.4.257

    Article  CAS  PubMed  Google Scholar 

  21. Maldague BE, Noel HM, Malghem JJ (1978) The intravertebral vacuum cleft: a sign of ischemic vertebral collapse. Radiology 129:23–29

    Article  CAS  Google Scholar 

  22. Ha KY, Kim YH (2012) Risk factors affecting progressive collapse of acute osteoporotic spinal fractures. Osteoporos Int 24(4):1207–1213

    Article  Google Scholar 

  23. Desai SK, Vadivelu S, Patel AJ, Brayton A, Jea A (2013) Isolated cervical spinal canal stenosis at C-1 in the pediatric population and in Williams syndrome. J Neurosurg Spine 18:558–563

    Article  Google Scholar 

  24. Vasikaran S, Eastell R, Bruyère O, Foldes AJ, Garnero P, Griesmacher A, McClung M, Morris HA, Silverman S, Trenti T, Wahl DA, Cooper C, Kanis JA (2011) Markers of bone turnover for the prediction of fracture risk and monitoring of osteoporosis treatment: a need for international reference standards. Osteoporos Int 22(2):391–420

    Article  CAS  Google Scholar 

  25. Lam CLK, Tse EYY, Gandek B, Fong DYT (2005) The SF-36 summary scales were valid, reliable, and equivalent in a Chinese population. J Clin Epidemiol 58(8):815–822

    Article  Google Scholar 

  26. Khanna AJ, Reinhardt MK, Togawa D, Lieberman IH (2006) Functional outcomes of kyphoplasty for the treatment of osteoporotic and osteolytic vertebral compression fractures. Osteoporos Int 17(6):817–826

    Article  CAS  Google Scholar 

  27. Tu P, Liu Z, Lee S, Chen J (2012) Treatment of repeated and multiple new-onset osteoporotic vertebral compression fractures with teriparatide. J Clin Neurosci 19(4):532–535. https://doi.org/10.1016/j.jocn.2011.04.048

    Article  CAS  PubMed  Google Scholar 

  28. Kawaguchi S, Horigome K, Yajima H, Oda T, Kii Y, Ida K, Yoshimoto M, Iba K, Takebayashi T, Yamashita T (2010) Symptomatic relevance of intravertebral cleft in patients with osteoporotic vertebral fracture. J Neurosurg Spine 13(2):267–275

    Article  Google Scholar 

  29. Nakamae T, Fujimoto Y, Yamada K, Takata H, Shimbo T, Tsuchida Y (2013) Percutaneous vertebroplasty for osteoporotic vertebral compression fracture with intravertebral cleft associated with delayed neurologic deficit. Eur Spine J 22:1624–1632

    Article  Google Scholar 

  30. Fabbriciani G, Pirro M, Floridi P, Manfredelli MR, Scarponi AM, Callarelli L, Mannarino E (2012) Osteoanabolic therapy: a non-surgical option of treatment for Kummell's disease? Rheumatol Int 32(5):1371–1374

    Article  Google Scholar 

  31. Farahmand P, Marin F, Hawkins F, Möricke R, Ringe JD, Glüer C-C, Papaioannou N, Minisola S, Martínez G, Nolla JM, Niedhart C, Guañabens N, Nuti R, Martín-Mola E, Thomasius F, Peña J, Graeff C, Kapetanos G, Petto H, Gentzel A, Reisinger A, Zysset PK (2013) Early changes in biochemical markers of bone formation during teriparatide therapy correlate with improvements in vertebral strength in men with glucocorticoid-induced osteoporosis. Osteoporos Int 24(12):2971–2981

    Article  CAS  Google Scholar 

  32. Hock J, Gera I (1992) Effects of continuous and intermittent administration and inhibition of resorption on the anabolic response of bone to parathyroid hormone. J Bone Miner Res 7(1):65–72. https://doi.org/10.1002/jbmr.5650070110

    Article  CAS  PubMed  Google Scholar 

  33. Esbrit P, Alcaraz M (2013) Current perspectives on parathyroid hormone (PTH) and PTH-related protein (PTHrP) as bone anabolic therapies. Biochem Pharmacol 85(10):1417–1423. https://doi.org/10.1016/j.bcp.2013.03.002

    Article  CAS  PubMed  Google Scholar 

  34. Jilka R (2007) Molecular and cellular mechanisms of the anabolic effect of intermittent PTH. Bone 40(6):1434–1446. https://doi.org/10.1016/j.bone.2007.03.017

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Funding

The National Natural Science Foundation of China (grants 81871124, 81471403, 81271360,30772193, and 81702110) supported this research.

Author information

Author notes

  1. P. Gou and Z. Wang contributed equally to this work.

Authors and Affiliations

  1. Department of Orthopedics Surgery, Tianjin Medical University General Hospital, Tianjin, 300052, China

    P. Gou, Z. Wang, Z. Zhao, Y. Wang & Y. Xue

  2. Key Laboratory of Spine and Spinal Cord, Tianjin Medical University General Hospital, Tianjin, 300052, China

    P. Gou, Z. Wang, Z. Zhao, Y. Wang & Y. Xue

  3. Department of Orthopedics Surgery, The Fifth People’s Hospital of Datong, Ping Cheng District, Datong, 037006, Shanxi, China

    P. Gou

  4. Department of Orthopedics Surgery, Tianjin Fourth Centre Hospital, Tianjin, 300140, China

    Z. Zhao

  5. Department of Orthopedics Surgery, The Second Hospital of Tianjin Medical University, Tianjin, 300211, China

    Y. Wang

  6. Department of Medical Image Center, Tianjin Medical University General Hospital, Tianjin, 300052, China

    Y. Jiang

Authors
  1. P. Gou
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Z. Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Z. Zhao
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Y. Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Y. Jiang
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Y. Xue
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Y. Xue.

Ethics declarations

Conflicts of interest

None.

Ethics approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the responsible institutional review boards and were in accordance with the ethical standards of the Declaration of Helsinki.

Consent to participate

Informed consent was obtained from all individual participants included in the study.

Consent for publication

The authors declare the consent for publication.

Code availability

Not applicable

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

ESM 1

(DOCX 2579 kb).

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gou, P., Wang, Z., Zhao, Z. et al. Restoration of the intravertebral stability in Kümmell’s disease following the treatment of severe postmenopausal osteoporosis by 1-34PTH—a retrospective study. Osteoporos Int 32, 1451–1459 (2021). https://doi.org/10.1007/s00198-020-05761-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00198-020-05761-x

Keywords

Search

Navigation