Change in spinal bone mineral density as estimated by Hounsfield units following osteoporosis treatment with romosozumab, teriparatide, denosumab, and alendronate: an analysis of 318 patients

Presented at the 2024 AANS/CNS Joint Section on Disorders of the Spine and Peripheral Nerves

Anthony L. Mikula Departments of Neurological Surgery,

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Nikita Lakomkin Departments of Neurological Surgery,

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Abdelrahman M. Hamouda Departments of Neurological Surgery,

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Megan C. Everson Departments of Neurological Surgery,

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Zach Pennington Departments of Neurological Surgery,

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Rahul Kumar Departments of Neurological Surgery,

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Zachariah W. Pinter Orthopedic Surgery,

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Michael L. Martini Departments of Neurological Surgery,

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Mohamad Bydon Departments of Neurological Surgery,

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Kurt A. Kennel Endocrinology, Diabetes, and Metabolism, and

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Francis Baffour Radiology, Mayo Clinic, Rochester, Minnesota;

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Ahmad Nassr Orthopedic Surgery,

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Brett Freedman Orthopedic Surgery,

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Arjun S. Sebastian Orthopedic Surgery,

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Kingsley Abode-Iyamah Department of Neurological Surgery, Mayo Clinic, Jacksonville, Florida; and

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Paul A. Anderson Department of Orthopedic Surgery, University of Wisconsin, Madison, Wisconsin

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Jeremy L. Fogelson Departments of Neurological Surgery,

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Benjamin D. Elder Departments of Neurological Surgery,

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OBJECTIVE

The purpose of this study was to determine the effect of osteoporosis medications on opportunistic CT-based Hounsfield units (HU).

METHODS

Spine and nonspine surgery patients were retrospectively identified who had been treated with romosozumab for 3 to 12 months, teriparatide for 3 to 12 months, teriparatide for > 12 months, denosumab for > 12 months, or alendronate for > 12 months. HU were measured in the L1–4 vertebral bodies. One-way ANOVA was used to compare the mean change in HU among the five treatment regimens.

RESULTS

In total, 318 patients (70% women) were included, with a mean age of 69 years and mean BMI of 27 kg/m2. There was a significant difference in mean HU improvement (p < 0.001) following treatment with romosozumab for 3 to 12 months (n = 32), teriparatide for 3 to 12 months (n = 30), teriparatide for > 12 months (n = 44), denosumab for > 12 months (n = 123), and alendronate for > 12 months (n = 100). Treatment with romosozumab for a mean of 10.5 months significantly increased the mean HU by 26%, from a baseline of 85 to 107 (p = 0.012). Patients treated with teriparatide for > 12 months (mean 23 months) experienced a mean HU improvement of 25%, from 106 to 132 (p = 0.039). Compared with the mean baseline HU, there was no significant difference after treatment with teriparatide for 3 to 12 months (110 to 119, p = 0.48), denosumab for > 12 months (105 to 107, p = 0.68), or alendronate for > 12 months (111 to 113, p = 0.80).

CONCLUSIONS

Patients treated with romosozumab for a mean of 10.5 months and teriparatide for a mean of 23 months experienced improved spinal bone mineral density as estimated by CT-based opportunistic HU. Given the shorter duration of effective treatment, romosozumab may be the preferred medication for optimization of osteoporotic patients in preparation for elective spine fusion surgery.

ABBREVIATIONS

BMD = bone mineral density; DXA = dual-energy x-ray absorptiometry; GFR = glomerular filtration rate; HU = Hounsfield units; kVp = peak kilovoltage; PTH = parathyroid hormone.
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