Teriparatide Shows Promise for Fusing Spine, Researchers Report

Injections of teriparatide could encourage bony healing and fusion in the spine and prevent future fractures in patients with osteoporosis, according to research presented at the American Association of Clinical Endocrinologists 23rd Annual Scientific & Clinical Congress in Las Vegas, Nev.

“The use of teriparatide appears to be an effective option for our patients who are at increased risk for pseudoarthroses or who have sustained fractures and elect to be treated conservatively,” Elaina Barraza, R.N., of SpineCal in Santa Monica, Cal., said during her presentation.

Barraza and Pablo Pazmino, M.D., reviewed radiographs of 18 patients with documented osteoporosis before and after a minimum of 12 months of daily teriparatide (Forteo, Eli Lilly) treatment. Patients were separated into cohorts: surgical fusions that appeared to be progressing slowly at least three months after the procedure (group 1, n=12) and spinal fractures treated without surgery (group 2, n=6).

The researchers followed up with all patients at three weeks, six weeks, three months, six months and one year, using radiographs and computed tomoghraphy scans (CT) to confirm final bony fusion; they also measured post treatment pain, visual analogue scale and quality of life.

In group 1, radiographic fusion and bony cortico-cancellous bridging were evaluated on postoperative CT scans. In group 2, kyphosis and wedge angle of the fractured vertebral body were measured. The researchers also examined ratios of anterior, middle and posterior heights of the fractured body to posterior height of the normal adjacent level vertebrae in order to obtain the degree of adjacent level collapse or asymptomatic progression of osteoporosis.

Progression of spinal cortical and cancellous fusion was observed in 100 percent of group 1. At one year, mean increments of kyphosis and wedge angle were unchanged in group 2 (6.3 and 5.3 degrees, respectively) and in adjacent level vertebral bodies. Improved bone mineral densities were seen in both groups following treatment.

“Our patients experienced rapid improvement and return to functional status, work and exercise, and these findings have been sustained,” Barraza said.