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. 2024 Jul 5;41(3):309-315.
doi: 10.3171/2024.4.SPINE2424. Print 2024 Sep 1.

Change in spinal bone mineral density as estimated by Hounsfield units following osteoporosis treatment with romosozumab, teriparatide, denosumab, and alendronate: an analysis of 318 patients

Anthony L Mikula  1 , Nikita Lakomkin  1 , Abdelrahman M Hamouda  1 , Megan C Everson  1 , Zach Pennington  1 , Rahul Kumar  1 , Zachariah W Pinter  2 , Michael L Martini  1 , Mohamad Bydon  1 , Kurt A Kennel  3 , Francis Baffour  4 , Ahmad Nassr  2 , Brett Freedman  2 , Arjun S Sebastian  2 , Kingsley Abode-Iyamah  5 , Paul A Anderson  6 , Jeremy L Fogelson  1 , Benjamin D Elder  1
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Change in spinal bone mineral density as estimated by Hounsfield units following osteoporosis treatment with romosozumab, teriparatide, denosumab, and alendronate: an analysis of 318 patients

Anthony L Mikula et al. J Neurosurg Spine. .

Abstract

Objective: The purpose of this study was to determine the effect of osteoporosis medications on opportunistic CT-based Hounsfield units (HU).

Methods: Spine and nonspine surgery patients were retrospectively identified who had been treated with romosozumab for 3 to 12 months, teriparatide for 3 to 12 months, teriparatide for > 12 months, denosumab for > 12 months, or alendronate for > 12 months. HU were measured in the L1-4 vertebral bodies. One-way ANOVA was used to compare the mean change in HU among the five treatment regimens.

Results: In total, 318 patients (70% women) were included, with a mean age of 69 years and mean BMI of 27 kg/m2. There was a significant difference in mean HU improvement (p < 0.001) following treatment with romosozumab for 3 to 12 months (n = 32), teriparatide for 3 to 12 months (n = 30), teriparatide for > 12 months (n = 44), denosumab for > 12 months (n = 123), and alendronate for > 12 months (n = 100). Treatment with romosozumab for a mean of 10.5 months significantly increased the mean HU by 26%, from a baseline of 85 to 107 (p = 0.012). Patients treated with teriparatide for > 12 months (mean 23 months) experienced a mean HU improvement of 25%, from 106 to 132 (p = 0.039). Compared with the mean baseline HU, there was no significant difference after treatment with teriparatide for 3 to 12 months (110 to 119, p = 0.48), denosumab for > 12 months (105 to 107, p = 0.68), or alendronate for > 12 months (111 to 113, p = 0.80).

Conclusions: Patients treated with romosozumab for a mean of 10.5 months and teriparatide for a mean of 23 months experienced improved spinal bone mineral density as estimated by CT-based opportunistic HU. Given the shorter duration of effective treatment, romosozumab may be the preferred medication for optimization of osteoporotic patients in preparation for elective spine fusion surgery.

Keywords: Hounsfield units; adult spinal deformity; bone mineral density; denosumab; diagnostic technique; romosozumab; teriparatide.

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