Lee Subum, Hur Junseok W, Oh Younggyu, An Sungjae, Chung Yeongu, Park Danbi, Park Jin Hoon
Department of Neurosurgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul 02841, Republic of Korea.
Department of Neurosurgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 03181, Republic of Korea.
J Clin Med. 2025 Jun 4;14(11):3967. doi: 10.3390/jcm14113967.
The debate continues, despite numerous studies, on whether vertebroplasty (VP) or conservative treatment is more suitable for osteoporotic vertebral compression fractures (OVCFs). Meanwhile, teriparatide (TP) has shown promise in accelerating bone healing in OVCFs. This analysis aims to clarify the potential benefits of conservative treatment using TP over VP from several clinical studies on acute OVCFs. A literature search was performed, using the MEDLINE, Embase, Cochrane Review, Web of Science, and Google Scholar databases, for studies published up until September 2023. Five studies [one randomized controlled study (RCT) and four non-RCTs] were included in a qualitative and quantitative synthesis. Data were extracted and analyzed using a random-effects model to obtain the effect size. Five studies with a total of 326 (TP = 147, VP = 179) patients were included. Within the first week of treatment, the VP group showed a significantly greater decrease in their visual analog scale (VAS) scores. There was no significant difference in VAS score reduction between the two groups from one to three months. However, after 6 months, the TP group exhibited significant superiority in VAS scores and bone mineral density (BMD). Furthermore, TP was associated with a reduced number of new-onset OVCFs, with a statistically significant estimated odds ratio of 0.15 (95% CI, 0.04-0.51, < 0.01). Conservative treatment using TP for acute OVCF has been found to reduce subsequent fractures, provide equivalent or superior pain control, and increase BMD compared to VP. Nonetheless, the meta-analysis results are weak, due to the low level of evidence.
尽管进行了大量研究，但关于椎体成形术（VP）和保守治疗哪种更适合骨质疏松性椎体压缩骨折（OVCFs）的争论仍在继续。与此同时，特立帕肽（TP）在加速OVCFs的骨愈合方面显示出前景。本分析旨在通过几项关于急性OVCFs的临床研究，阐明使用TP进行保守治疗相对于VP的潜在益处。使用MEDLINE、Embase、Cochrane综述、科学网和谷歌学术数据库进行文献检索，以查找截至2023年9月发表的研究。五项研究[一项随机对照试验（RCT）和四项非RCT]被纳入定性和定量综合分析。使用随机效应模型提取和分析数据以获得效应大小。纳入了五项研究，共有326名患者（TP组 = 147名，VP组 = 179名）。在治疗的第一周内，VP组的视觉模拟量表（VAS）评分显著下降更多。从1个月到3个月，两组在VAS评分降低方面没有显著差异。然而，6个月后，TP组在VAS评分和骨密度（BMD）方面表现出显著优势。此外，TP与新发OVCFs数量减少相关，估计优势比为0.15，具有统计学意义（95%CI，0.04 - 0.51，<0.01）。已发现使用TP对急性OVCF进行保守治疗与VP相比，可减少后续骨折，提供同等或更好的疼痛控制，并增加BMD。尽管如此，由于证据水平较低，荟萃分析结果的说服力较弱。
