2023, Vol. 27 ›› Issue (9): 1427-1433

Systematical evaluation of bone fusion rate after interbody fusion in patients with osteoporosis and lumbar degenerative disease treated with teriparatide

Jiang Xiaocheng1, 2, Shi Lu2, Wang Yinbin3, Li Qiujiang1, 2, Xi Chuangzhen1, 2, Ma Zefeng1, 2, Cai Lijun1, 3   

Abstract: OBJECTIVE: To systematically review the changes of bone fusion rate after interbody fusion in patients with osteoporosis and lumbar degenerative disease treated with teriparatide.
METHODS: A comprehensive search of PubMed, Embase, Cochrane library, Home-ClinicalTrials (US clinical trial database), CNKI, Wanfang, VIP, Chinese Biomedical Literature Service System and Chinese clinical trial database was performed with “teriparatide, spinal fusion, spondylodesis, randomized controlled trial, randomized, placebo” as English search terms and “teriparatide, spinal fusion, lumbar fusion, interbody fusion” as Chinese search terms. The search time was from database establishment to November 16, 2021. All randomized controlled trials of teriparatide after lumbar fusion in patients with osteoporosis and lumbar degeneration were collected. The methodological quality of the literature was analyzed using the Cochrane Review Manual. Primary outcome measures were the rate of bone fusion, the number of patients with pedicle screw loosening, and the rate of pedicle screw loosening. Secondary outcome measure was the Oswestry Disability Index score for low back pain at 12-month follow-up. Meta-analysis was performed using RevMan 5.3 and Stata 16.0 software.
RESULTS: (1) A total of 9 high-quality research articles were included, including 536 patients. (2) Meta-analysis results showed that bone fusion rate was significantly increased in the teriparatide group compared with the control group at 6-month follow-up [RR=1.96, 95%CI(1.38-2.80), Z=3.73, P=0.000 2 < 0.05], but there was no significant difference in bone fusion rate between teriparatide group and control group at 12-month follow-up [RR=1.02, 95%CI(0.88-1.17), Z=0.23, P=0.82 > 0.05], suggesting that teriparatide can improve postoperative bone fusion rate and shorten bone fusion time in osteoporotic patients with lumbar degenerative diseases. (3) At a follow-up time of 12 months, the loosening rate of pedicle screws in the teriparatide group was significantly lower than that in the control group (P < 0.05). (4) There was no significant difference in the number of pedicle screw loosening between the teriparatide group and the risedronate group [RR=0.99, 95%CI(0.58-1.70), Z=0.02, P=0.98 > 0.05], but the number of pedicle screw loosening could be significantly reduced in the teriparatide group compared with the risedronate group [RR=0.50, 95%CI(0.32-0.78), Z=3.05, P=0.002 < 0.05].
CONCLUSION: (1) Teriparatide can promote bone fusion and shorten bone fusion time. (2) Teriparatide can reduce the incidence of pedicle screw loosening. (3) The effect of teriparatide on postoperative low back pain Oswestry Disability Index score cannot be clarified.
Key words: teriparatide, osteoporosis, lumbar fusion, interbody fusion, meta-analysis, randomized controlled trial