Comparison of Romosozumab and Two Forms of Teriparatide for the Prevention of Vertebral Body Fractures Following Balloon Kyphoplasty

<p>Introduction: Teriparatide has been used for the prevention of subsequent vertebral body fractures (SVBFs) following balloon kyphoplasty (BKP) and for the treatment of osteoporosis because it is efficacious in preventing SVBFs and is considered to be the most suitable alternative for this purpose. Romosozumab, an antisclerostin antibody, was made available in March 2019. A higher efficacy for the prevention of post-BKP SVBFs is expected from this drug as it effectively prevents vertebral body fractures and increases the bone density. In this study, we aimed to evaluate the efficacy of romosozumab in preventing SVBFs in comparison with other drugs, such as teriparatide, and obtain an index for selecting the optimal drug for patients after BKP.</p><p>Methods: A total of 320 patients who underwent initial BKP for vertebral compression fractures in our hospital were retrospectively analyzed, classified into four groups, and received romosozumab therapy (group R: 35 cases), daily teriparatide therapy (group D: 62 cases), weekly teriparatide therapy (group W: 122 cases), or alendronate therapy (control) (group C: 101 cases). Patients in these four groups were compared in terms of the 1-year incidence of SVBFs, rate of change in bone density, visual analog scale, and Oswestry Disability Index.</p><p>Results: The incidence of SVBFs was 8.6% in group R, 8.1% in group D, 6.6% in group W, and 13.9% in group C. In comparison with group C, the rate of change in lumbar vertebral bone density was significantly higher in group R at 4 months (+3.2%), 8 months (+5.9%), and 1 year (+10.8%), and in group D at 1 year (+3.3%).</p><p>Conclusions: Romosozumab increased vertebral bone density most prominently; however, the incidence of SVBFs in romosozumab therapy was similar to that of the two regimens of teriparatide therapy. The results suggest that the use of teriparatide or romosozumab mainly decreases the incidence of distant vertebral body fractures, leading to a decrease in the incidence of post-BKP SVBFs. Romosozumab is considered useful particularly for patients with severe osteoporosis, who require a rapid increase in the bone density.</p>