双膦酸盐和特立帕肽在胸腰椎脊柱融合术中的应用：系统评价和荟萃分析的比较研究。

Bisphosphonate and Teriparatide Use in Thoracolumbar Spinal Fusion: A Systematic Review and Meta-analysis of Comparative Studies.

机构信息

UCLA Medical Center, Los Angeles, CA.

Case Western Reserve School of Medicine, Cleveland, OH.

出版信息

Spine (Phila Pa 1976). 2018 Sep 1;43(17):E1014-E1023. doi: 10.1097/BRS.0000000000002608.

DOI:10.1097/BRS.0000000000002608

PMID:29462070

Abstract

STUDY DESIGN

Systematic review and meta-analysis.

OBJECTIVE

To compare the efficacy of the use of either bisphosphonates or teriparatide on radiographic and functional outcomes of patients that had thoracolumbar spinal fusion.

SUMMARY OF BACKGROUND DATA

Controversy exists as to whether bisphosphonates interfere with successful spinal arthrodesis. An alternative osteoporosis medication is teriparatide, a synthetic parathyroid hormone that has an anabolic effect on osteoblast function. To date, there is limited comparative data on the influence of bisphosphonates or teriparatide on spinal fusion.

METHODS

A systematic search of medical reference databases was conducted for comparative studies on bisphosphonate or teriparatide use after thoracolumbar spinal fusion. Meta-analysis was performed using the random-effects model for heterogeneity. Radiographic outcomes assessed include fusion rates, risk of screw loosening, cage subsidence, and vertebral fracture.

RESULTS

No statistically significant differences were noted between bisphosphonates and control groups regarding fusion rate and risk of screw loosening (fusion: odds ratio [OR] = 2.2, 95% confidence interval [CI]: 0.87-5.56, P = 0.09; loosening: OR = 0.45, 95% CI: 0.14-1.48, P = 0.19). Teriparatide use was associated with higher fusion rates than bisphosphonates (OR = 2.3, 95% CI: 1.55-3.42, P < 0.0001). However, no statistically significant difference was noted between teriparatide and bisphosphonates regarding risk of screw loosening (OR = 0.37, 95% CI: 0.12-1.18, P = 0.09). Lastly, bisphosphonate use was associated with decreased odds of cage subsidence and vertebral fractures compared to controls (subsidence: OR = 0.29, 95% CI 0.11-0.75, P = 0.01; fracture: OR = 0.18, 95% CI 0.07-0.48, P = 0.0007).

CONCLUSION

Bisphosphonates do not appear to impair successful spinal fusion compared to controls although teriparatide use is associated with higher fusion rates than bisphosphonates. In addition, bisphosphonate use is associated with decreased odds of cage subsidence and vertebral fractures compared to controls that had spinal fusion.

LEVEL OF EVIDENCE

摘要

研究设计

系统评价和荟萃分析。

目的

比较使用双膦酸盐或特立帕肽对接受胸腰椎脊柱融合术的患者的影像学和功能结果的疗效。

背景资料概要

关于双膦酸盐是否会干扰成功的脊柱融合存在争议。另一种骨质疏松症药物是特立帕肽，这是一种合成甲状旁腺激素，对成骨细胞功能具有合成代谢作用。迄今为止，关于双膦酸盐或特立帕肽对脊柱融合的影响的比较数据有限。

方法

对医学参考数据库进行了系统搜索，以寻找关于胸腰椎脊柱融合后使用双膦酸盐或特立帕肽的比较研究。使用随机效应模型进行荟萃分析以评估异质性。评估的影像学结果包括融合率、螺钉松动风险、笼沉降和椎体骨折。

结果

在融合率和螺钉松动风险方面，双膦酸盐组与对照组之间没有统计学上的显著差异（融合：优势比[OR] = 2.2，95%置信区间[CI]：0.87-5.56，P = 0.09；松动：OR = 0.45，95%CI：0.14-1.48，P = 0.19）。特立帕肽的使用与更高的融合率相关，而不是双膦酸盐（OR = 2.3，95%CI：1.55-3.42，P < 0.0001）。然而，在螺钉松动风险方面，特立帕肽与双膦酸盐之间没有统计学上的显著差异（OR = 0.37，95%CI：0.12-1.18，P = 0.09）。最后，与对照组相比，双膦酸盐的使用与降低的笼沉降和椎体骨折的几率相关（沉降：OR = 0.29，95%CI 0.11-0.75，P = 0.01；骨折：OR = 0.18，95%CI 0.07-0.48，P = 0.0007）。