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Teriparatide and bisphosphonate use in osteoporotic spinal fusion patients: a systematic review and meta-analysis

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Abstract

Purpose

Osteoporosis is one of the most common conditions among adults worldwide. It also presents a challenge among patients undergoing spinal surgery. Use of Teriparatide and bisphosphonates in such patients has been shown to improve outcomes after fusion surgery, including successful fusion, decreased risk of instrumentation failure, and patient-reported outcomes. Herein, we performed a systematic review and indirect meta-analysis of available literature on outcomes of fusion surgery after use of bisphosphonates or Teriparatide.

Methods

We conducted a comprehensive search of all databases (Ovid MEDLINE(R) and Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Ovid Embase, Ovid Cochrane Central Register of Controlled Trials, Ovid Cochrane Database of Systematic Reviews, and Scopus) to identify studies assessing outcomes of spinal fusion among osteoporotic patients after use of Teriparatide or bisphosphonate. Four authors independently screened electronic search results, and all four authors independently performed study selection. Two authors performed independent data extraction and assessed the studies’ risk of bias assessment using standardized forms of Revised Cochrane risk-of-bias tool for randomized trials (RoB 2) and Risk Of Bias In Non-randomized Studies of Interventions (ROBINS-I).

Results

Nineteen studies were included in the final analysis. A total of 13 studies evaluated the difference in fusion rate between bisphosphonates and Teriparatide or control group. Fusion rate was higher for bisphosphonates (effect size (ES) 83%, 95% CI 77–89%) compared with Teriparatide (ES 71%, 95% CI 57–85%), with the p value for heterogeneity between groups without statistical significance (p = 0.123). Five studies assessed the impact of using bisphosphonate or Teriparatide on screw loosening. The rate of screw loosening was higher for bisphosphonates (ES 19%, 95% CI 13–25%) compared with Teriparatide (ES 13%, 95% CI 9–16%) without statistical significance (p = 0.52).

Conclusion

Our results indicate that while both agents may be associated with positive outcomes, bisphosphonates may be associated with a higher fusion rate, while Teriparatide may be associated with lower screw loosening. The decision to treat with either agent should be tailored individually for each patient keeping in consideration the adverse effect and pharmacokinetic profiles.

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Authors and Affiliations

  1. Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    Sung Huang Laurent Tsai, Katie Lichter & Raghad Alharthy

  2. Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Keelung branch, Keelung 204 and School of medicine, Chang Gung University, Taoyuan 333, Taiwan., F7, No 222 Mai-King Road, Keelung, Taiwan

    Sung Huang Laurent Tsai, Ruei-Shyuan Chien, Tsai-Sheng Fu & Tung-Yi Lin

  3. Mayo Clinic Neuro-Informatics Laboratory, Mayo Clinic, Rochester, MN, USA

    Mohammed Ali Alvi, Anshit Goyal & Mohamad Bydon

  4. Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA

    Mohamad Bydon

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Presented as a poster at the Orthopedic Research Society Annual Meeting February 8–11, 2020, at Phoenix, Arizona

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Tsai, S.H.L., Chien, RS., Lichter, K. et al. Teriparatide and bisphosphonate use in osteoporotic spinal fusion patients: a systematic review and meta-analysis. Arch Osteoporos 15, 158 (2020). https://doi.org/10.1007/s11657-020-00738-z

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