Impact of Baseline Denosumab and Teriparatide Treatments in Lumbar Degenerative Disc Disease Patients with Osteoporosis Undergoing One- to Two-Level Posterior Decompression and Fusion Surgery

Introduction: Osteoporosis is a primary cause of mechanical implant failure and subsequent pseudoarthrosis in patients undergoing spinal fusion surgery. Common treatments for osteoporosis include bisphosphonates, teriparatide, and denosumab, all of which have been shown to increase bone mineral density. Further research is necessary to fully characterize the impact of osteoinductive medications on complication outcomes in patients undergoing lumbar fusion.

Methods: The PearlDiver Database was queried from 2010-2021 for patients with lumbar degenerative disc disease (DDD) and osteoporosis who underwent one- to two-level lumbar laminectomy and fusion. Patients receiving either denosumab or teriparatide within six months pre-surgery were propensity-matched 1:1 with untreated controls using age, gender, and Charlson Comorbidity Index (CCI) as covariates. Primary outcomes included surgical complications—defined as pseudoarthrosis, implant failure, or reoperation—within two years of index surgery. Secondary outcomes assessed included hospital readmissions at 30 and 90 days and hospital length of stay. Sensitivity analyses included univariate and multivariable models for outcome comparison.

Results: The 1:1 matched cohort included 102 patients in each group. Following multivariate analysis, preoperative denosumab treatment within six months before surgery was linked to significantly reduced surgery-related complications over two years (OR=0.28, 95% CI: 0.12–0.65, p=0.004) and a decrease in extended hospital stays (6+ days) (OR=0.14, 95% CI: 0.02–0.65, p=0.019). Baseline treatment with denosumab was also associated with an increased frequency of shorter hospital stays (1-3 days) (OR=3.16, 95% CI: 1.26–8.44, p=0.017). Preoperative treatment with teriparatide resulted in a significant reduction in composite surgical complications compared to the control cohort (OR=0.04, 95% CI: 0.01–0.14, p< 0.001) and similarly reduced the incidence of extended stays (OR=0.16, 95% CI: 0.03–0.74, p=0.024). Baseline treatment with denosumab further increased the likelihood of a shorter (1-3 day) hospital stay (OR=5.28, 95% CI: 1.61–19.54, p=0.008). No significant differences in 30- and 90-day readmission rates were observed across matched cohorts (p>0.05).

Conclusion : Our findings indicate that in patients with osteoporosis and degenerative disc disease, baseline treatment with denosumab or teriparatide for 6 months before a primary one- to two-level lumbar laminectomy and fusion surgery is associated with a significant decrease in surgical-related complications as well as hospital length of stay.