Skip to main content
SpringerLink
Log in

Effects of zoledronic acid on bone fusion in osteoporotic patients after lumbar fusion

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

Abstract

Summary

Treatment with zoledronic acid in osteoporotic patients with spinal fusion shortens the duration of time to fusion, improves the fusion rate, prevents the subsequent adjacent vertebral compression fractures, improves the clinical outcomes, and prevents immobilization-induced bone loss in the hip.

Introduction

The objective of the study was to explore the effects of zoledronic acid on the healing process in osteoporotic patients following spinal fusion in a randomized, placebo-controlled, and triple-blinded study.

Methods

Seventy-nine osteoporotic patients with single-level degenerative spondylolisthesis were randomly assigned to receive either zoledronic acid infusion (zoledronic acid group) or saline infusion (controls) after spinal fusion. Functional radiography and CT scans were used to evaluate fusion status. Bone formation was graded into three categories: Grade A (bridging bone bonding with adjacent vertebral bodies), Grade B (bridging bone bonding with either superior or inferior vertebral body), or Grade C (incomplete bony bridging). A solid fusion was defined as less than 5° of angular motion with Grade A or B bone formation. Adjacent vertebral compression fractures (VCF) were assessed on MRI at 12 months after surgery. Serum level of carboxy terminal cross-linked telopeptide of type I collagen (β-CTX) and amino-terminal propeptide of type I procollagen (PINP) was measured. Bone mineral density (BMD) was measured by DXA. Oswestry Disability Index (ODI) was used to assess the clinical outcomes.

Results

Grade A or B bridging bone was more frequently observed in zoledronic acid group at 3, 6, and 9 months post-operation compared to the control group (p < 0.05). At 12 -months post-operation, bridging bone and solid fusion were not significantly different between groups. No patients in zoledronic acid group showed aVCF, whereas six patients (17 %) in the control group did (p < 0.05). Both β-CTX and PINP were suppressed in zoledronic acid group. BMD at the femoral neck decreased rapidly and did not return to the preoperative level in the controls at 3 (−1.4 %), 6 (−2.5 %), and 12 (−0.8 %) months after surgery. Zoledronic acid prevented this immobilization-induced bone loss and increased BMD. ODI showed the improved clinical outcomes compared with controls at 9 and 12 months post-surgery.

Conclusion

Treatment with zoledronic acid in osteoporotic patients with spinal fusion shortens the time to fusion, improves the fusion rate, prevents subsequent aVCFs, and improves clinical outcomes.

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
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Etebar S, Cahill DW (1999) Risk factors for adjacent-segment failure following lumbar fixation with rigid instrumentation for degenerative instability. J Neurosurg 90(2 Suppl):163–169

    CAS  PubMed  Google Scholar 

  2. Ponnusamy KE, Iyer S, Gupta G, Khanna AJ (2011) Instrumentation of the osteoporotic spine: biomechanical and clinical considerations. Spine J 11(1):54–63

    Article  PubMed  Google Scholar 

  3. Guppy K, Paxton L, Harris J, Alvarez J, Bernbeck J (2014) Does bone morphogenic protein (BMP) change the operative nonunion rates in spine fusions? Spine (Phila Pa 1976) 39(22):1831–1839

    Article  Google Scholar 

  4. Manolagas SC, Jilka RL (1995) Bone marrow, cytokines, and bone remodeling. Emerging insights into the pathophysiology of osteoporosis. N Engl J Med 332(5):305–311

    Article  CAS  PubMed  Google Scholar 

  5. Tella SH, Gallagher JC (2014) Prevention and treatment of postmenopausal osteoporosis. J Steroid Biochem Mol Biol 142:155–170

    Article  CAS  PubMed  Google Scholar 

  6. Dai Z, Dai R, Xiao Y et al (2010) Progress in anti-osteoporosis drug treatment. Chin J Osteoporos 16(11):894–906

    CAS  Google Scholar 

  7. Schimmer RC, Bauss F (2003) Effect of daily and intermittent use of ibandronate on bone mass and bone turnover in postmenopausal osteoporosis: a review of three phase II studies. Clin Ther 25(1):19–34

    Article  CAS  PubMed  Google Scholar 

  8. Zou X, Xue Q, Li H, Bünger M, Lind M, Bünge C (2003) Effect of alendronate on bone ingrowth into porous tantalum and carbon fiber interbody devices: an experimental study on spinal fusion in pigs. Acta Orthop Scand 74(5):596–603

    Article  PubMed  Google Scholar 

  9. Xue Q, Li H, Zou X et al (2010) Alendronate treatment improves bone-pedicle screw interface fixation in posterior lateral spine fusion: an experimental study in a porcine model. Int Orthop 34(3):447–451

    Article  PubMed  Google Scholar 

  10. Huang RC, Khan SN, Sandhu HS et al (2005) Alendronate inhibits spine fusion in a rat model. Spine 30(22):2516–2522

    Article  PubMed  Google Scholar 

  11. Nagahama K, Kanayama M, Togawa D, Hashimoto T, Minami A (2011) Does alendronate disturb the healing process of posterior lumbar interbody fusion? A prospective randomized trial. J Neurosurg Spine 14(4):500–507

    Article  PubMed  Google Scholar 

  12. Recker RR, Delmas PD, Halse J et al (2008) Effects of intravenous zoledronic acid once yearly on bone remodeling and bone structure. J Bone Miner Res 23(1):6–16

    Article  CAS  PubMed  Google Scholar 

  13. Seeman E, Martin TJ (2015) Co-administration of antiresorptive and anabolic agents: a missed opportunity. J Bone Miner Res 30(5):753–764

    Article  CAS  PubMed  Google Scholar 

  14. Bransford R, Goergens E, Briody J et al (2007) Effect of zoledronic acid in an L6-L7 rabbit spine fusion model. Eur Spine J 16(4):557–562

    Article  PubMed  Google Scholar 

  15. Fairbank JC, Pynsent PB (2000) The oswestry disability index. Spine 25(22):2940–2952

    Article  CAS  PubMed  Google Scholar 

  16. Russell RG, Watts NB, Ebetino FH, Rogers MJ (2008) Mechanisms of action of bisphosphonates: similarities and differences and their potential influence on clinical efficacy. Osteoporos Int 19(6):733–759

    Article  CAS  PubMed  Google Scholar 

  17. Gamsjaeger S, Buchinger B, Zwettler E et al (2011) Bone material properties in actively bone-forming trabeculae in postmenopausal women with osteoporosis after three years of treatment with once-yearly zoledronic acid. J Bone Miner Res 26(1):12–18

    Article  CAS  PubMed  Google Scholar 

  18. Bransford R, Goergens E, Briody J et al (2007) Effect of zoledronic acid in an L6-L7 rabbit spine fusion model. Eur Spine J 16(4):557–562

    Article  PubMed  Google Scholar 

  19. Yalçin N, Öztürk A, Ozkan Y (2011) The effects of zoledronic acid and hyperbaric oxygen on posterior lumbar fusion in a rabbit model. J Bone Joint Surg Br 93(6):793–800

    Article  PubMed  Google Scholar 

  20. Tu CW, Huang KF, Hsu HT et al (2014) Zoledronic acid infusion for lumbar interbody fusion in osteoporosis. J Surg Res 192(1):112–116

    Article  CAS  PubMed  Google Scholar 

  21. Boonen S, Orwoll E, Magaziner J et al (2011) Once-yearly zoledronic acid in older men compared with women with recent hip fracture. J Am Geriatr Soc 59(11):2084–2090

    Article  PubMed  Google Scholar 

  22. Tamma R, Zallone A (2012) Osteoblast and osteoclast crosstalks: from OAF to Ephrin. Inflamm Allergy Drug Targets 11(3):196–200

    Article  CAS  PubMed  Google Scholar 

  23. Ohtori S, Inoue G, Orita S et al (2013) Comparison of teriparatide and bisphosphonate treatment to reduce pedicle screw loosening after lumbar spinal fusion surgery in postmenopausal women with osteoporosis from a bone quality perspective. Spine 38(8):E487–492

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This research was supported by “the Fundamental Research Funds for the Central Universities” (2012QNZT148), Science and Technology Plan of Hunan Province (2012WK3039) and National Institutes of Health (P01 CA093900)

Author information

Authors and Affiliations

  1. Department of Spine Surgery, The 2nd Xiangya Hospital, Central South University, Changsha, 410011, China

    F. Chen, Z. Dai, Y. Kang & G. Lv

  2. Osteoporosis and Arthritis Lab, University of Michigan, Ann Arbor, MI, 48109, USA

    Y. Jiang

  3. Department of Urology, University of Michigan, Ann Arbor, MI, 48109, USA

    E. T. Keller & Y. Jiang

  4. Biointerfaces Institute, University of Michigan, Ann Arbor, MI, 48109, USA

    E. T. Keller

  5. Comprehensive Cancer Center, University of Michigan, Ann Arbor, MI, 48109, USA

    E. T. Keller & Y. Jiang

Authors
  1. F. Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Z. Dai
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Y. Kang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. G. Lv
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. E. T. Keller
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Y. Jiang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Z. Dai.

Ethics declarations

The ethics committee of the Central South University approved the study.

Conflicts of interest

None

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Chen, F., Dai, Z., Kang, Y. et al. Effects of zoledronic acid on bone fusion in osteoporotic patients after lumbar fusion. Osteoporos Int 27, 1469–1476 (2016). https://doi.org/10.1007/s00198-015-3398-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00198-015-3398-1

Keywords

Search

Navigation