The Impact of Teriparatide on Clinical and Patient-Reported Outcomes in the Setting of Long-Segment Spine Fusion

Osteoporosis is a common comorbidity encountered in adult spinal deformity patients and is associated with increased perioperative and postoperative complications, including increased blood loss, pseudoarthrosis, and hardware failure. Teriparatide is a pro-osteogenic anabolic agent used to improve bone quality in patients with osteoporosis. This study evaluates the ability of teriparatide to mitigate complications in this cohort.

Patients diagnosed with adult spinal deformity who underwent long-segment thoracolumbar spine surgery at our institution between 2016 and 2020 were included in this study. Inclusion criteria include age >17 years, >5 levels of fusion, and use of pelvic instrumentation. A retrospective chart review was performed collecting demographic, radiographical, and treatment-related data with cohorts stratified by teriparatide therapy.

There were 83 total patients that fit inclusion criteria. Twenty-two osteoporotic/osteopenic patients received teriparatide before surgery and 61 patients with normal bone density did not. Demographic differences were observed between the teriparatide group and nonteriparatide group regarding sex ( P = .014), body mass index ( P = .026), and preoperative dual energy X-ray absorptiometry scan T-score ( P < .001). Mechanical complications were not significantly different between cohorts at 1 year or 2 years. Change in Short Form Health Survey-36 pain scores at 1 year from time of index surgery was the only patient-reported outcome that was different between cohorts ( P = .018).

The use of teriparatide before surgery for adult spinal deformity in patients with osteoporosis results in a similar complication profile to those undergoing spine surgery without osteoporosis and/or teriparatide use.