Introduction
Recombinant parathyroid hormone (rPTH) is considered one of the preferred interventions for treatment of osteoporosis, particularly beneficial for patients who need simultaneous treatment for both osteoporosis and existing fractures. This therapeutic approach enhances bone density and strength, consequently lowering the risk of future fractures.
Aim
To evaluate the effectiveness of rPTH, i.e., teriparatide in the treatment of thoracolumbar osteoporosis and alleviating the related back pain.
Patient Profile
- Patients with an age range of 47–85 years and without any evident osteoporotic fractures were diagnosed with a T-score (>- 2.5) of their lumbar spine bone mineral density (BMD), indicating osteoporosis.
- Also they were Osteoporotic patients with persistent back pain who were unresponsive to conservative treatments. .
Methods
- BMD of the osteoporotic patients was assessed using bone scans to build a T-score index and their pain level was evaluated using the Oswestry Disability Index (ODI) after the first and second years of the treatment
- In addition to these, a Short Form Health Survey (SF- 36) was conducted at the end of the second year to assess overall health and well-being
Results
Figure 1: Improvement in T-score index for bone mineral density (BMD) in both groups
- All groups demonstrated statistically significant enhancements in disability scores over the two-year duration, with the teriparatide group exhibiting a more pronounced effect relative to the bisphosphonate group, which served as the standard comparator.
Figure 2 : Oswestry Disability Index Scores (ODI) over two years of treatment both groups
- Patient who received teriparatide showed improvements in social functioning and pain reduction over the same period (P<0.05)
Table 1 : Comparison of both groups in the SF-36 questionnaire
|
|
Teriparatide group |
Bisphosphonate group |
||
|
Scale |
Before treatment |
After treatment |
Before treatment |
After Treatment |
|
General Health |
85.3 (-/+ 14) |
90.2 (-/+ 14) |
86.2 (-/+ 13.5) |
91.3 (-/+ 14) |
|
Limitation of Activity |
73.1 (-/+ 30.2) |
82.1 (-/+ 15.2) |
74.2 (-/+ 20.1) |
78.1 (-/+ 14.2) |
|
Emotional Health Problem |
85(-/+ 30.3) |
86 (-/+ 28.2) |
83 (-/+ 28.2) |
87 (-/+ 28.4) |
|
Social Activities |
78(-/+ 19.2) |
88 (-/+ 16.5) |
78.2 (-/+ 17.3) |
82 (-/+ 16.2) |
|
Pain |
62.2 (-/+ 13.5) |
80.3 (-/+ 17.95) |
68.2 (-/+ 19.1) |
71.2 (-/+ 14.5) |
Conclusion
- Teriparatide demonstrates promising efficacy as a minimally invasive treatment for alleviating lower back pain and managing osteoporosis in lumbar and thoracic vertebrae, with minimal side effects.
- The two-year study revealed significant improvements in the ODI and specific domains of the SF-36 questionnaire compared to bisphosphonates.
Reference
Journal of Orthopaedics 66;2025:104-109
