Treatment with either teriparatide or percutaneous vertebroplasty significantly and similarly improved quality of life and reduced pain in patients with acute osteoporotic vertebral compression fractures, according to study results published in Bone. However, the cost of teriparatide treatment was significantly lower compared with percutaneous vertebroplasty.
While previous studies reported teriparatide is an effective treatment option for osteoporosis, limited data are available on the use of teriparatide for acute spinal compression fractures. However, a preliminary investigation showed that teriparatide was effective in treating acute osteoporotic vertebral compression fractures. Based on this evidence, the current study was conducted to compare the therapeutic effects of teriparatide treatment over 3 months with those of percutaneous vertebroplasty.
The prospective nonrandomized real-world study included postmenopausal women aged 55 to 80 years with acute osteoporotic vertebral compression fractures and severe low back pain. Based on the patient’s choice, each received either subcutaneous teriparatide (20 µg once daily; conservative group) or percutaneous vertebroplasty in combination with oral alendronate therapy (70 mg once weekly).
The visual analog score, Oswestry Disability Index, and Short Form 36-item questionnaire were used to assess patients’ symptoms, physical ability, and health quality. Magnetic resonance imaging was performed 3 months after treatment to assess fracture healing in the teriparatide group.
The study cohort included 60 patients, equally assigned to conservative treatment or percutaneous vertebroplasty. All 30 patients who underwent percutaneous vertebroplasty were hospitalized for treatment, while only 3 of 30 patients in the teriparatide group were hospitalized.
Teriparatide and percutaneous vertebroplasty with alendronate were associated with significant and similar improvements in quality of life after 1 and 3 months; both treatments significantly reduced the visual analog and Oswestry Disability Index scores. There was no clear difference between the groups except that percutaneous vertebroplasty was more effective in reducing pain at 1 week (P <.05).
Bone healing was evident on imaging in most patients treated with teriparatide (24 of 27 patients; 89%). Measurement of the height change revealed that while there was a significant increase in the height of the middle column of the injured vertebra in the percutaneous vertebroplasty group, this was not evident in the teriparatide-treated patients (P <.05).
The total cost of teriparatide treatment was calculated to be less than treatment with percutaneous vertebroplasty. Similar bone healing and quality of life 3 months after treatment were achieved with teriparatide, which costs 30% less than percutaneous vertebroplasty, indicating a superior economic effect (P =.000).
The researchers noted the study had several limitations, including the nonrandomized single-center study design, short follow-up period, and missing data on social and financial status of the patients, which may affect treatment choice and perception of quality of life.
“The conservative treatment strategy with [teriparatide] obtained similar therapeutic effects but cost less than [percutaneous vertebroplasty] in the treatment of acute [osteoporotic vertebral compression fractures], thus indicating a more preferable therapeutic approach,” concluded the researchers.
Ma Y, Wu X, Xiao X, et al. Effects of teriparatide versus percutaneous vertebroplasty on pain relief, quality of life and cost-effectiveness in postmenopausal females with acute osteoporotic vertebral compression fracture: a prospective cohort study. Bone. 2020;131:115154.