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Background <p>Percutaneous vertebroplasty (PVP) is widely utilized for managing osteoporotic vertebral compression fractures (OVCFs), yet its long-term efficacy remains controversial. Previous studies have overlooked the potential impact of anti-osteoporotic medications on PVP outcomes. This study evaluates the clinical benefits of PVP combined with alendronate (ALN) or sequential teriparatide (TPTD)/ALN therapy in postmenopausal women with acute OVCFs.</p> Method <p>In this prospective cohort study, 216 postmenopausal women with fresh OVCFs were allocated to four groups based on patients’ preference: ALN monotherapy (ALN group), PVP combined with ALN therapy (ALN + PVP group), sequential therapy with TPTD for 6 months followed by ALN (TPTD group), and PVP combined with sequential TPTD/ALN therapy (TPTD + PVP group). Pain (Visual Analog Scale, VAS), disability (Oswestry Disability Index, ODI), and health-related quality of life (Medical Outcomes Study 36-Item Short Form Health Survey, SF-36) were assessed at 3, 6, and 12 months by one-way ANOVA. New vertebral fracture incidence was monitored biannually.</p> Results <p>Compared to ALN group, the ALN + PVP, TPTD and TPTD + PVP groups exhibited significantly improved VAS scores at 3, 6 and 12 months (<i>p &lt;</i> 0.05), as well as superior SF-36 scores at 3 and 6 months (<i>p &lt;</i> 0.05). No significant differences in VAS, ODI or SF-36 scores were observed among ALN + PVP, TPTD and TPTD + PVP groups during follow-up (<i>p &gt;</i> 0.05), except TPTD + PVP group exhibited a statistically superior improvement than ALN + PVP group in SF-36 scores at 12 months. New vertebral fracture incidences at 30 months were 10.0% (ALN), 19.0% (ALN + PVP), 5.4% (TPTD) and 14.3% (TPTD + PVP).</p> Conclusions <p>The application of anti-osteoporotic medicine could affect the beneficial effect evaluation of PVP. Sequential TPTD/ALN therapy achieved comparable pain relief and health-related quality of life improvements to PVP combined with anti-osteoporotic agents, while demonstrating the lowest long-term refracture rate. These findings suggest that conservative sequential TPTD/ALN therapy may serve as an effective alternative to PVP in acute OVCFs management. Larger randomized trials are warranted to validate these results.</p> Clinical trial registration number <p>NCT03692143</p>

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Sequential anti-osteoporotic therapy with teriparatide and alendronate optimizes outcomes of percutaneous vertebroplasty in acute osteoporotic vertebral fractures: a 12-month prospective cohort study

  • 期刊论文

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  • 发表日期：

    2025年10月29日

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  • Yafen Xie,
  • Shangbo Niu,
  • Yangyang Ma,
  • Yuanjing Liao,
  • Yongjian Zhu,
  • Lan Feng,
  • Minghui Zheng,
  • Dehong Yang

摘要

Background

Percutaneous vertebroplasty (PVP) is widely utilized for managing osteoporotic vertebral compression fractures (OVCFs), yet its long-term efficacy remains controversial. Previous studies have overlooked the potential impact of anti-osteoporotic medications on PVP outcomes. This study evaluates the clinical benefits of PVP combined with alendronate (ALN) or sequential teriparatide (TPTD)/ALN therapy in postmenopausal women with acute OVCFs.

Method

In this prospective cohort study, 216 postmenopausal women with fresh OVCFs were allocated to four groups based on patients’ preference: ALN monotherapy (ALN group), PVP combined with ALN therapy (ALN + PVP group), sequential therapy with TPTD for 6 months followed by ALN (TPTD group), and PVP combined with sequential TPTD/ALN therapy (TPTD + PVP group). Pain (Visual Analog Scale, VAS), disability (Oswestry Disability Index, ODI), and health-related quality of life (Medical Outcomes Study 36-Item Short Form Health Survey, SF-36) were assessed at 3, 6, and 12 months by one-way ANOVA. New vertebral fracture incidence was monitored biannually.

Results

Compared to ALN group, the ALN + PVP, TPTD and TPTD + PVP groups exhibited significantly improved VAS scores at 3, 6 and 12 months (p < 0.05), as well as superior SF-36 scores at 3 and 6 months (p < 0.05). No significant differences in VAS, ODI or SF-36 scores were observed among ALN + PVP, TPTD and TPTD + PVP groups during follow-up (p > 0.05), except TPTD + PVP group exhibited a statistically superior improvement than ALN + PVP group in SF-36 scores at 12 months. New vertebral fracture incidences at 30 months were 10.0% (ALN), 19.0% (ALN + PVP), 5.4% (TPTD) and 14.3% (TPTD + PVP).

Conclusions

The application of anti-osteoporotic medicine could affect the beneficial effect evaluation of PVP. Sequential TPTD/ALN therapy achieved comparable pain relief and health-related quality of life improvements to PVP combined with anti-osteoporotic agents, while demonstrating the lowest long-term refracture rate. These findings suggest that conservative sequential TPTD/ALN therapy may serve as an effective alternative to PVP in acute OVCFs management. Larger randomized trials are warranted to validate these results.

Clinical trial registration number

NCT03692143