Efficacy of Three Teriparatide Preparations and Romosozumab, Osteogenesis Promoters, in the Treatment of Fresh Vertebral Fractures: A Retrospective Observational Study

Abstract

Background: In Japan, daily, twice weekly, and weekly formulations of teriparatide (TPD) and monthly formulations of romosozumab (ROMO) are available as osteogenesis promoters for the treatment of osteoporosis with a high risk for fracture.

Objective: To compare the effects of three TPD preparations and ROMO on fracture healing and low back pain after a fresh vertebral fracture.

Methods: This was a retrospective observational study. Patients presenting with fresh osteoporotic vertebral fractures were treated subcutaneously with TPD daily (DTPD), twice weekly (2/WTPD), weekly (WTPD), or with ROMO monthly. Bone union, vertebral height changes, and low back pain in the injured vertebra were compared after 6 months of treatment.

Results: Bone union and pain improvement were more frequent among those who received daily and twice weekly administration of TPD compared with those who received WTPD and ROMO administration. A comparison for multiplicity between the groups using the Steel-Dwass test showed significant differences between the DTPD and ROMO groups (p = 0.0029) and WTPD and ROMO groups (p = 0.0490), suggesting superior bone fusion in the DTPD and WTPD groups. Similarly, significant differences were noted between the DTPD and ROMO groups (p = 0.0001), WTPD and ROMO groups (p = 0.0341), and 2/WTPD and ROMO groups (p = 0.0009), indicating a higher degree of pain improvement in the DTPD, WTPD, and 2/WTPD groups compared with that in the ROMO group.

Conclusions: Daily, weekly, and twice-weekly administration of TPD may be superior to ROMO for promoting fresh vertebral fracture healing.

Fig. 1

Bone adhesion after 6 months of administration of TPD or ROMO. Fisher’s exact test, p = 0.0184. Comparison between groups considering multiplicity (Steel–Dwass test). DTPD versus WTPD, p = 0.9200; DTPD versus 2/ WTPD, p = 0.3533; DTPD versus ROMO, p = 0.0029; WTPD versus 2/WTPD, p = 0.8060; 2/WTPD versus ROMO, p = 0.0490, WTPD versus ROMO, p = 0.2790. Baseline vertebral height (mm) was as follows—DTPD: 12.14 ± 4.40 (mean ± SD), 2/WTPD: 13.48 ± 3.15, WTPD: 13.77 ± 4.81, ROMO: 16.22 ± 5.22

Fig. 2

Improvement in low-back pain after 6 months administration of TPD or ROMO. Fisher’s exact test, p = 0.0001. Comparison between groups considering multiplicity (Steel–Dwass test). DTPD versus WTPD, p = 0.2490; DTPD versus 2/WTPD, p = 0.9568; DTPD versus ROMO, p = 0.0001; WTPD versus 2/WTPD, p = 0.5675; WTPD versus ROMO, p = 0.0341; 2/WTPD versus ROMO, p = 0.0009