Teriparatide use in osteopenic patients undergoing single-level lumbar fusion associated with decreased 2-year revision rates.

Context: Low bone density is common among lumbar fusion patients and increases the risks of pseudarthrosis, hardware failure, and revision. Teriparatide improves bone mass and fusion in osteoporosis, but its benefit in osteopenia or normal bone remains uncertain. Aims: To evaluate the association between teriparatide exposure and (1) postoperative complications, (2) 90-day readmission, and (3) 2-year reoperation, stratified by bone health status (osteoporotic, osteopenic, and normal) in patients undergoing single-level lumbar fusion. Setting and Design: A retrospective cohort study using the PearlDiver database from 2010 to 2021 identified patients undergoing single-level lumbar fusion. Subjects and Methods: Patients on teriparatide were matched 1:5 to controls based on age, gender, obesity status, bisphosphonate use, and Elixhauser Comorbidity Index. Patients were categorized by bone health status: Normal, osteopenic, or osteoporotic. Outcomes included postoperative complications, 90-day readmissions, and 2-year revision rates. Statistical Analysis Used: Chi-square tests and multivariate logistic regressions were used for analysis, with statistical significance set at Results: The analysis included 3527 teriparatide users and 17,576 controls. Teriparatide use was associated with significantly lower 90-day readmission and 2-year revision rates in osteopenic and normal bone health patients compared to osteoporotic patients. However, osteopenic patients on teriparatide experienced higher rates of deep vein thrombosis (1.8% vs. 0.4%, Conclusions: Among osteopenic patients, teriparatide was linked to fewer 2-year revisions but higher 90-day thromboembolic events. These findings support nuanced risk-benefit discussions and highlight the need for trials clarifying indications across bone-health categories.