Perioperative teriparatide in adult spinal deformity: a retrospective comparative cohort study

Adults with low bone mineral density (BMD) face higher risks of implant loosening, pseudarthrosis, and junctional complications following long-segment spinal deformity reconstruction. Teriparatide (TPTD), an anabolic agent that enhances bone formation, may improve fixation strength and fusion quality. This study compared outcomes between patients with low BMD who received perioperative TPTD and those with normal BMD undergoing long-segment adult spinal deformity (ASD) surgery.

In a retrospective comparative cohort study, 50 consecutive adults who underwent thoracolumbar fusion with pelvic fixation between June 2022 and January 2024 were included. Patients were classified into two cohorts: normal BMD (n = 30) and anabolic users (n = 20), who received daily subcutaneous TPTD (20 µg) starting 3 months before surgery and continued for three months after. Clinical outcomes were assessed with the Oswestry Disability Index (ODI) and visual analog scale (VAS) for pain. Radiographic alignment parameters and complication rates were also compared.

Baseline characteristics were similar, except for lower BMD in the TPTD group (mean T-score -1.7 vs 0.95, P < 0.001). Both groups showed marked improvements in ODI (-42.5 vs -40.0, P = 0.447) and VAS pain (-5.1 vs -6.7, P = 0.282). Sagittal alignment correction was comparable between groups, and there were no significant differences in rates of pseudarthrosis (45.0% vs 33.3%), proximal junctional kyphosis (10.0% vs 16.6%), or reoperation (30.0% vs 16.6%). No medication-related adverse effects were noted.

Perioperative TPTD in low-BMD patients demonstrated similar clinical, radiographic, and complication outcomes to those of patients with normal bone density undergoing long-segment ASD reconstruction. These results contribute to the role of structured bone-health optimization in ASD surgery but cannot be attributed to TPTD alone.