Analysis of radiologic and clinical outcome in acute osteoporotic vertebral compression fracture: Single-agent teriparatide vs. teriparatide with subsequent vertebroplasty.

Objectives: To analyze the difference in union and clinical outcomes between teriparatide (T) and teriparatide with vertebroplasty (V) treatment modalities in osteoporotic vertebral compression fractures (OVCFs). Methods: Patients were divided into two groups (T and V: 87 and 92 patients with 105 fractures each). Radiological features (fracture type/grade, presence of fracture gap/intravertebral vacuum cleft (IVVC)/posterior vertebral wall fracture, change in compression rate (CR)/kyphotic angle (CA), and fusion status) were assessed with 3D-CT at 3 and 6 months. The outcome was divided into success or failure based on visual analog scale (<3), absence of percussion tenderness on the spinous process, and pain during motion. Univariate and multivariate analyses were performed to identify risk factors for nonunion and failed outcomes in each group. Results: The V group showed more favorable results than the T group at 3 months (CR>10%, 58% vs. 17%; CA>5°, 36% vs. 16%; union, 66% vs. 91%; successful outcome, 77% vs. 94%). At 6 months, no significant change was detected in CR and CA. A significant difference remained in union (89% vs. 100%) and successful outcomes (79% vs. 100%). The V group with age (>75 years) and initial CR (>40%) had more benefits than the T group in the subgroup analysis. In multivariate analysis for the T group, nonunion risk factors were hypertension (P = .0054) and fracture gap (P = .0075). IVVC (P = .047) was the sole risk factor for failure. Conclusions: Teriparatide with subsequent vertebroplasty can be selected as the first-line treatment with better sequelae and outcomes in acute osteoporotic compression fractures.