Combined teriparatide and denosumab therapy accelerates spinal fusion following posterior lumbar interbody fusion

Abstract

Introduction: Previous studies reported that teriparatide (recombinant human parathyroid hormone) accelerated spinal fusion following posterior lumbar inter-body fusion surgery, and combination therapy using teriparatide and denosumab increased bone marrow density more than teriparatide alone. The purpose of this study is to evaluate the influence of combination therapy with teriparaide and denosumab on spinal fusion after posterior lumbar interbody fusion.

Materials and methods: Sixteen osteoporotic patients with lumbar canal stenosis were randomly divided into two treatment groups, a teriparatide group (n=8; 20μg of teriparatide daily alone, administered from a month before surgery to 12 months after surgery) and a combination group (n=8; 20μg of teriparatide administered daily from a month before surgery to 12 months after surgery with 60mg denosumab every 6 months, administered at 2 and 8 months following surgery). All patients underwent posterior lumbar interbody fusion with local bone grafts. At 3, 6, 9, and 12 months following surgery, bone mineral density at the femoral neck was measured, and biochemical markers were obtained for bone turnover for all cases. Clinical findings were quantified using the Japanese Orthopedic Association scores before surgery, and at 6 and 12 months following surgery. Fusion rates were measured using computed tomography images before surgery, and 6 and 12 months following surgery.

Results: Alkaline phosphatase in the teriparatide group increased more than in the combination group at 3 months following surgery (p<0.05). Femoral neck BMD increased more in the combination group than in the teriparatide group at 12 months following surgery. The combination group achieved higher fusion rates than the teriparatide group at 6 months following surgery.

Conclusions: Combination therapy with teriparatide and denosumab increased bone mineral density more than teriparatide alone, and accelerated spinal fusion following posterior lumbar interbody fusion.

Keywords: Combination therapy; Denosumab; Posterior lumbar interbody fusion; Spinal fusion; Teriparatide.