Impact of Baseline Denosumab and Teriparatide Treatment in Patients with Osteoporosis Undergoing Cervical Spine Decompression and Fusion Surgery: A Propensity Score-Matched Analysis

Introduction: Osteoporosis is co-prevalent with degenerative disorders of the cervical spine, and has been shown to adversely affect outcomes. Previous studies have demonstrated that drug treatment, particularly with denosumab and teriparatide (osteoinductive drugs), may be associated with a lower risk of osseous fractures.

Methods: The PearlDiver Database was queried from January 2010 to December 2019 for patients with a diagnosis of osteoporosis who underwent cervical laminectomy and fusion. Patients were propensity matched in a 1:1:1 ratio in to (1) denosumab group; (2) teriparatide group; and (3) control group (no treatment) controlling for age, gender, and Charlson comorbidity index (CCI) as matching covariates. A sensitivity analysis [univariate and multivariable analyses] was performed by head-to-head comparison of the primary outcome [a composite measure (CM) of surgical complications: pseudoarthrosis or mechanical failure or return to the operating room] between the matched cohorts at 2-year following the cervical decompression and fusion surgery. Secondary outcomes included 30-and 90-day hospital readmission rates, as well as hospital length of stay.

Results: The matched cohort included 164 patients in each treatment group and the control group, respectively. In a multivariate analysis, baseline teriparatide treatment 6 months before the index surgery was associated with a significant decrease in surgical-related complications [OR= 0.12, 95% CI: (0.05 to 0.26), (p < 0.001)] and 90-day hospital readmission [OR= 0.39, 95% CI: (0.19 to 0.78), (p=0.008)] two years following index surgery. Similarly, a 6-month baseline denosumab treatment before the index surgery was associated with a significant decrease in surgical-related complications [OR= 0.12, 95% CI: (0.05 to 0.25), (p < 0.001)] and 90-day hospital readmission [OR= 0.52, 95% CI: (0.27 to 0.97), (p=0.041)] two years following index surgery. No significant differences were observed in hospital length of stay between the matched cohorts (p>0.05).

Conclusion : Our findings suggest that in patients with osteoporosis, baseline treatment with denosumab or teriparatide for 6 months prior to index cervical laminectomy and fusion surgery is associated with a significant decrease in surgical-related complications and 90-day hospital readmission.