Parathyroid Hormone Injection Versus Vertebroplasty in the Treatment of Osteoporotic Vertebral Fracture in Old Age: A Retrospective Study of 49 Patients

초록

Study Design: Case-control retrospective study. Objectives: To compare the effects of percutaneous vertebroplasty (VP) and parathyroid hormone (PTH) administration in patients with osteoporotic vertebral fracture (OVF), as well as to investigate the optimal duration of PTH injections. Summary of literature review: Although the indications of PTH for osteoporosis prevention and management have been established, its indications for the treatment of OVF remain unknown. Materials and Methods: We retrospectively studied elderly patients with OVF between 2015 and 2019. Treatment was selected based on the patient’s modified frailty index (mFI), preference, and severity of osteoporosis. Group C was administered PTH once weekly, whereas group I underwent VP. Both groups then received anti-resorptive agent administration. Radiological parameters (e.g., local kyphotic angle, vertebral height, and height loss ratio), clinical parameters such as VAS, and complications were analyzed between the two groups. Results: Forty-nine female patients were included. Group C included 18 patients with a mean age of 78.2 years (range, 65–85 years), while group I included 31 patients with a mean age of 77.4 years (range, 65–92 years). There was no significant difference between the two groups in initial demographic, clinical, and radiographic parameters, except for a higher mFI in group C (p<0.01). Group I showed significantly better clinical and radiological outcome at the last follow-up. Regarding side effects in group C, two cases of dizziness (11.1%) and nausea and vomiting (11.1%) were reported. In group I, cement leakage was found in 20 vertebrae (64.5%), and related complications were observed in four patients (12.9%). Conclusions: Conservative treatment using PTH demonstrated inferior clinical and radiological outcomes compared to vertebroplasty. However, PTH injections demonstrated a lower risk of procedure-related complications. The patient’s frailty and preferences with respect to the severity of osteoporosis should be considered when determining treatment options for OVF in old age.

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