Impact of Preoperative Teriparatide Use on Proximal Junctional Kyphosis Prevention in Osteopenic/Osteoporotic Patients Undergoing Adult Spinal Deformity Surgery: A Propensity Score-Matched Study
Preoperative teriparatide did not significantly reduce the incidence of proximal junctional kyphosis or failure in osteopenic/osteoporotic patients undergoing spinal surgery.
Where it sits
this study against the rest of the teriparatide (pth 1-34) corpusSummary and findings
This study assessed the impact of preoperative teriparatide on the incidence of proximal junctional kyphosis (PJK) and proximal junctional failure (PJF) in osteopenic/osteoporotic patients undergoing adult spinal deformity surgery. A total of 292 patients were reviewed, with 59 receiving teriparatide and 233 not. The study found no significant difference in PJK or PJF incidence between the two groups.
Abstract
<h4>Background: </h4> /Objectives: Poor bone quality significantly increases the risk of mechanical complications after adult spinal deformity (ASD) surgery, including proximal junctional kyphosis (PJK) and proximal junctional failure (PJF). Although teriparatide enhances bone quality, its effectiveness in preventing junctional complications after extensive correction remains unclear. This study investigated whether preoperative teriparatide administration reduces the incidence of PJK and PJF in patients with compromised bone quality undergoing ASD surgery. <h4>Methods:</h4> This retrospective cohort study reviewed 292 patients (T-score < -1.0) who underwent ASD surgery between 2015 and 2023. Patients were divided into teriparatide (n = 59) and non-teriparatide (n = 233) groups. Propensity score matching (1:2 ratio) was performed using six covariates: age, preoperative pelvic incidence minus lumbar lordosis, preoperative T1 pelvic angle, upper instrumented vertebra (UIV) cementing, UIV screw angle, and fusion length, yielding 153 matched patients (52 teriparatide, 101 non-teriparatide). <h4>Results:</h4> After matching, all baseline characteristics were well-balanced. The incidence of PJK and PJF did not differ significantly between the teriparatide and non-teriparatide groups (44.2% vs. 52.5%, P = 0.426; 9.6% vs. 9.9%, P = 1.000), nor did PJK subtype distribution (bony vs. soft-tissue). Multivariate analysis identified older age (odds ratio [OR] = 1.058), higher American Society of Anesthesiologists score (OR = 2.603, P = 0.002), UIV at the thoracolumbar junction (OR = 2.786), and greater postoperative thoracic kyphosis (OR = 1.044) as independent risk factors for PJK. Teriparatide use was not an independent predictor (OR = 0.872). <h4>Conclusions:</h4> Preoperative teriparatide did not significantly reduce the incidence of PJK or PJF after long-segment fusion for ASD. These findings suggest that improving bone quality alone is insufficient to prevent junctional complications, which are driven by complex biomechanical and patient-related factors inherent to extensive deformity correction.