Treatment of osteoporosis with medications like teriparatide, a parathyroid hormone, is known to improve bone density and reduce the risk of osteoporotic vertebral fractures. Anecdotal and limited surgical series have described the utility of this treatment for osteoporotic patients prior to spinal fusion surgery, but there is variability in adoption of this strategy as well as consensus regarding optimal treatment duration before and after surgery. In this study, the clinical results of the use of teriparatide for this application are reviewed and critically examined. We conducted a systematic review of electronic databases using different MeSH terms from 1980 to 2020. Pooled and subgroup analyses were performed using fixed and random effect models based upon the heterogeneity (I2). The results were reported as either mean difference (MD) or odds ratio (OR) with 95% confidence interval (CI). A total of 771 patients from 12 studies were identified. Three hundred seventy-seven patients (90.8% females) were treated with teriparatide. Lumbar spinal fusion rates were significantly higher among patients who received teriparatide compared to the non-teriparatide group (OR 2.15, 95%CI 1.56-2.97, p < 0.00001). Subgroup analysis revealed that patients receiving teriparatide demonstrated 2.12-fold and 2.23-fold higher likelihood of fusion compared to those in the bisphosphonate (OR 2.12, 95%CI 1.45-3.11, p = 0.0001) and placebo (OR 2.23, 95%CI 1.22-4.08, p = 0.009) cohorts, respectively. The treatment effect of teriparatide was associated with significantly reduced subsequent vertebral fractures (OR 0.16, 95%CI 0.06-0.41, p = 0.0002), sagittal malalignment (MD - 3.85, 95%CI: -6.49 to - 1.21, p = 0.004), limb visual analogue score (VAS) (MD - 0.36, 95%CI - 0.64 to - 0.09, p = 0.008), and spinal VAS (MD - 0.24, 95%CI - 0.44 to - 0.04, p = 0.02) compared to the non-teriparatide group. Patients using teriparatide had 30% less likelihood of screw loosening at last follow-up compared to the non-teriparatide group; however, this was not statistically significant (OR 0.70, 95%CI 0.43-1.14, p = 0.15). There did not exist any statistically significant difference between the two comparative groups in terms of pseudoarthrosis (OR 0.54, 95%CI 0.24-1.21, p = 0.13), cage subsidence (OR 1.30, 95%CI 0.38-4.52, p = 0.68), and bone mineral density (MD 0.04, 95%CI - 0.19-0.29, p = 0.74) at last follow-up examination. This meta-analysis corroborates the effectiveness of teriparatide resulting in higher fusion rates. Further study is required to determine the optimal duration of treatment and timing of surgery.

中文翻译：

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评估特立帕肽治疗骨质疏松症对腰椎融合手术结果的疗效：系统评价和荟萃分析。

众所周知，用特立帕肽（一种甲状旁腺激素）等药物治疗骨质疏松症可以提高骨密度并降低骨质疏松性椎骨骨折的风险。传闻和有限的手术系列已经描述了这种治疗在脊柱融合手术前对骨质疏松患者的效用，但在采用这种策略以及关于手术前后最佳治疗持续时间的共识方面存在差异。在这项研究中，审查和严格审查了特立帕肽用于该应用的临床结果。我们对 1980 年至 2020 年使用不同 MeSH 术语的电子数据库进行了系统审查。使用基于异质性 (I2) 的固定和随机效应模型进行合并和亚组分析。结果报告为具有 95% 置信区间 (CI) 的平均差 (MD) 或优势比 (OR)。共确定了来自 12 项研究的 771 名患者。377 名患者（90.8% 女性）接受了特立帕肽治疗。与非特立帕肽组相比，接受特立帕肽治疗的患者腰椎融合率显着更高（OR 2.15，95%CI 1.56-2.97，p < 0.00001）。亚组分析显示，与双膦酸盐（OR 2.12，95%CI 1.45-3.11，p = 0.0001）和安慰剂（OR 2.23，95%CI 1.22）相比，接受特立帕肽的患者融合的可能性分别高出 2.12 倍和 2.23 倍-4.08, p = 0.009) 队列，分别。特立帕肽的治疗效果与随后椎骨骨折的显着减少相关（OR 0.16, 95% CI 0.06-0.41, p = 0. 0002），矢状位不正（MD - 3.85，95% CI：-6.49 至 - 1.21，p = 0.004），肢体视觉模拟评分（VAS）（MD - 0.36，95%CI - 0.64 至 - 0.09，p = 0.008）和脊柱 VAS（MD - 0.24，95% CI - 0.44 至 - 0.04，p = 0.02）与非特立帕肽组相比。与非特立帕肽组相比，使用特立帕肽的患者在最后一次随访时螺钉松动的可能性降低了 30%；然而，这在统计学上并不显着（OR 0.70，95% CI 0.43-1.14，p = 0.15）。两个比较组在假关节（OR 0.54，95%CI 0.24-1.21，p = 0.13）、笼子下陷（OR 1.30，95%CI 0.38-4.52，p = 0.68）方面无统计学差异和骨矿物质密度（MD 0.04，95%CI - 0.19-0.29，p = 0.74）在最后一次随访检查中。该荟萃分析证实了特立帕肽导致更高融合率的有效性。需要进一步研究以确定最佳治疗持续时间和手术时机。