The Impact of Teriparatide on Clinical and Patient-Reported Outcomes in the Setting of Long-Segment Spine Fusion

BACKGROUND AND OBJECTIVES: Osteoporosis is a common comorbidity encountered in adult spinal deformity patients and is associated with increased perioperative and postoperative complications, including increased blood loss, pseudoarthrosis, and hardware failure. Teriparatide is a pro-osteogenic anabolic agent used to improve bone quality in patients with osteoporosis. This study evaluates the ability of teriparatide to mitigate complications in this cohort. METHODS: Patients diagnosed with adult spinal deformity who underwent long-segment thoracolumbar spine surgery at our institution between 2016 and 2020 were included in this study. Inclusion criteria include age >17 years, >5 levels of fusion, and use of pelvic instrumentation. A retrospective chart review was performed collecting demographic, radiographical, and treatment-related data with cohorts stratified by teriparatide therapy. RESULTS: There were 83 total patients that fit inclusion criteria. Twenty-two osteoporotic/osteopenic patients received teriparatide before surgery and 61 patients with normal bone density did not. Demographic differences were observed between the teriparatide group and nonteriparatide group regarding sex ( P = .014), body mass index ( P = .026), and preoperative dual energy X-ray absorptiometry scan T-score ( P < .001). Mechanical complications were not significantly different between cohorts at 1 year or 2 years. Change in Short Form Health Survey-36 pain scores at 1 year from time of index surgery was the only patient-reported outcome that was different between cohorts ( P = .018). CONCLUSION: The use of teriparatide before surgery for adult spinal deformity in patients with osteoporosis results in a similar complication profile to those undergoing spine surgery without osteoporosis and/or teriparatide use.