Special Poster Session 50th International Society for the Study of the Lumbar Spine Annual Meeting 2024

CLINICAL AND RADIOGRAPHIC OUTCOMES OF CONSERVATIVE TREATMENT OF ACUTE OSTEOPOROTIC SPINAL FRACTURES USING DIFFERENT ANABOLIC ANTI-OSTEOPOROTIC AGENTS: A RETROSPECTIVE ANALYSIS OF PROSPECTIVELY DESIGNED COHORT. (#SP-5c)

Gang-Un Kim 1 , Young-Il Ko 2 , Joonghyun Ahn 3 , Hyung-youl Park 4 , Young-Hoon Kim 2
  1. Orthopaedic Surgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, South Korea
  2. Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
  3. Orthopaedic Surgery, Bucheon St. Mary's Hospital, The Catholic University of Korea, Bucheon, South Korea
  4. Orthopaedic Surgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea

INTRODUCTION:  Among anti-osteoporosis medications, anabolic agents, including teriparatide, are strongly recommended as first-line treatments for the treatment of severe osteoporosis accompanied by acute osteoporotic fracture. However, despite the use of new anabolic agents such as romosozumab, little is known about the therapeutic effects of anabolic anti-osteoporosis treatment in osteoporotic spinal fractures (OSF). This study was designed to elucidate the treatment effect of two existing anabolic antiosteoporosis agents, teriparatide and romosozumab, on acute osteoporotic spinal fracture through clinical and radiographic outcomes.

METHODS:   A total of 80 patients who were diagnosed with acute OSFs were enrolled and they were allocated into 3 groups: Group N (n=26, no anti-osteoporosis medication use), group T (n=22, Teriparatide use) and group 3 (n=26, Romosozumab use) by the use of anabolic anti-osteoporosis agents during initial fracture healing periods (12 weeks following diagnosis). For clinical results, numeric rating scale (NRS) for back pain and Oswestry disability index (ODI) were assessed and compared. Radiological parameters including vertebral height loss (HL, %), kyphotic angle (KA, ˚), and wedge angle (WA, ˚) with their changes during follow-up were measured at the plain lateral radiographs. The presence of intravertebral cleft (IVC) and fracture instability at the index vertebra were assessed by magnetic resonance imaging (MRI). In addition, the proportion of patients with impaired fracture healing (IFL, HL change >15%, KA change >10˚) in each group during the follow-up period was investigated.

RESULTS: Pain NRS showed no significant difference among the three groups or between each group, but ODI showed a significantly higher score in the T group at the follow-up 4 weeks (T=51.6±17.1, N=42.3±10.5, R=41.8±7.8, p=0.008). The change in KA in each follow-up period was significantly lower in the R group than in the T group at 4 weeks (R=1.2±3.7, T=6.5±7.8, p=0.002), and significantly lower in the R group than the N and T groups at 12 weeks (R=0.3±6.7, N=6.0±5.7, T=7.4±8.6, p=0.004 (R-N) / <0.001 (R-T)). The number of patients with KA change >10˚ was significantly lower in the R group at the 4 (p=0.035 (R-N) / <0.001 (R-T)) and 12 weeks of follow-up (p=0.006 (R-N) / <0.001 (R-T)). Also, at 12 weeks of follow-up, the proportion of overall IFH patients in the R group was significantly lower (p=0.019 (R-N) / <0.029 (R-T)).

DISCUSSION:  Our results showed that the use of romosozumab in acute OSF significantly reduced the change in the kyphosis angle of the fracture segment and the incidence of impaired fracture healing during a 12-week follow-up period compared to non-treatment and teriparatide use. On the other hand, in clinical outcomes including pain NRS and ODI, the use of anabolic agents did not show significant differences compared to no osteoporosis treatment.

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