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The effect of denosumab on pedicle screw fixation: a prospective 2-year longitudinal study using finite element analysis

BACKGROUND: Pedicle screw loosening is a major complication following spinal fixation associated with osteoporosis in elderly. However, denosumab is a promising treatment in patients with osteoporosis. The effect of denosumab on pedicle screw fixation is unknown. Therefore, we investigated whether d...

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Autores principales: Tani, Soji, Ishikawa, Koji, Kudo, Yoshifumi, Tsuchiya, Koki, Matsuoka, Akira, Maruyama, Hiroshi, Emori, Haruka, Yamamura, Ryo, Hayakawa, Chikara, Sekimizu, Masaya, Oshita, Yusuke, Ozawa, Tomoyuki, Shirahata, Toshiyuki, Nagai, Takashi, Toyone, Tomoaki, Inagaki, Katsunori
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7995779/
https://www.ncbi.nlm.nih.gov/pubmed/33771178
http://dx.doi.org/10.1186/s13018-021-02360-2
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author Tani, Soji
Ishikawa, Koji
Kudo, Yoshifumi
Tsuchiya, Koki
Matsuoka, Akira
Maruyama, Hiroshi
Emori, Haruka
Yamamura, Ryo
Hayakawa, Chikara
Sekimizu, Masaya
Oshita, Yusuke
Ozawa, Tomoyuki
Shirahata, Toshiyuki
Nagai, Takashi
Toyone, Tomoaki
Inagaki, Katsunori
author_facet Tani, Soji
Ishikawa, Koji
Kudo, Yoshifumi
Tsuchiya, Koki
Matsuoka, Akira
Maruyama, Hiroshi
Emori, Haruka
Yamamura, Ryo
Hayakawa, Chikara
Sekimizu, Masaya
Oshita, Yusuke
Ozawa, Tomoyuki
Shirahata, Toshiyuki
Nagai, Takashi
Toyone, Tomoaki
Inagaki, Katsunori
author_sort Tani, Soji
collection PubMed
description BACKGROUND: Pedicle screw loosening is a major complication following spinal fixation associated with osteoporosis in elderly. However, denosumab is a promising treatment in patients with osteoporosis. The effect of denosumab on pedicle screw fixation is unknown. Therefore, we investigated whether denosumab treatment improves pedicle screw fixation in elderly patients with osteoporosis. METHODS: This was a 2-year prospective open-label study. From February 2015 to January 2016, we included 21 patients with postmenopausal osteoporosis who received initial denosumab treatment. At baseline, 12 months, and 24 months, we measured volumetric bone mineral density (BMD) using quantitative computed tomography (QCT) and performed CT-based finite element analysis (FEA). Finite element models of L4 vertebrae were created to analyze the bone strength and screw fixation. RESULTS: BMD increased with denosumab treatment. FEA revealed that both pullout strength of pedicle screws and compression force of the vertebra increased significantly at 12 and 24 months following denosumab treatment. Notably, pullout strength showed a stronger correlation with three-dimensional volumetric BMD around pedicle screw placement assessed by QCT (r = 0.83, at 24 months) than with two-dimensional areal BMD assessed by dual energy X-ray absorptiometry (r = 0.35, at 24 months). CONCLUSION: To our knowledge, this is the first study to reveal that denosumab treatment achieved strong pedicle screw fixation with an increase in BMD around the screw assessed by QCT and FEA; therefore, denosumab could be useful for osteoporosis treatment during spinal surgery in elderly patients with osteoporosis.
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spelling pubmed-79957792021-03-30 The effect of denosumab on pedicle screw fixation: a prospective 2-year longitudinal study using finite element analysis Tani, Soji Ishikawa, Koji Kudo, Yoshifumi Tsuchiya, Koki Matsuoka, Akira Maruyama, Hiroshi Emori, Haruka Yamamura, Ryo Hayakawa, Chikara Sekimizu, Masaya Oshita, Yusuke Ozawa, Tomoyuki Shirahata, Toshiyuki Nagai, Takashi Toyone, Tomoaki Inagaki, Katsunori J Orthop Surg Res Research Article BACKGROUND: Pedicle screw loosening is a major complication following spinal fixation associated with osteoporosis in elderly. However, denosumab is a promising treatment in patients with osteoporosis. The effect of denosumab on pedicle screw fixation is unknown. Therefore, we investigated whether denosumab treatment improves pedicle screw fixation in elderly patients with osteoporosis. METHODS: This was a 2-year prospective open-label study. From February 2015 to January 2016, we included 21 patients with postmenopausal osteoporosis who received initial denosumab treatment. At baseline, 12 months, and 24 months, we measured volumetric bone mineral density (BMD) using quantitative computed tomography (QCT) and performed CT-based finite element analysis (FEA). Finite element models of L4 vertebrae were created to analyze the bone strength and screw fixation. RESULTS: BMD increased with denosumab treatment. FEA revealed that both pullout strength of pedicle screws and compression force of the vertebra increased significantly at 12 and 24 months following denosumab treatment. Notably, pullout strength showed a stronger correlation with three-dimensional volumetric BMD around pedicle screw placement assessed by QCT (r = 0.83, at 24 months) than with two-dimensional areal BMD assessed by dual energy X-ray absorptiometry (r = 0.35, at 24 months). CONCLUSION: To our knowledge, this is the first study to reveal that denosumab treatment achieved strong pedicle screw fixation with an increase in BMD around the screw assessed by QCT and FEA; therefore, denosumab could be useful for osteoporosis treatment during spinal surgery in elderly patients with osteoporosis. BioMed Central 2021-03-26 /pmc/articles/PMC7995779/ /pubmed/33771178 http://dx.doi.org/10.1186/s13018-021-02360-2 Text en © The Author(s) 2021 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research Article
Tani, Soji
Ishikawa, Koji
Kudo, Yoshifumi
Tsuchiya, Koki
Matsuoka, Akira
Maruyama, Hiroshi
Emori, Haruka
Yamamura, Ryo
Hayakawa, Chikara
Sekimizu, Masaya
Oshita, Yusuke
Ozawa, Tomoyuki
Shirahata, Toshiyuki
Nagai, Takashi
Toyone, Tomoaki
Inagaki, Katsunori
The effect of denosumab on pedicle screw fixation: a prospective 2-year longitudinal study using finite element analysis
title The effect of denosumab on pedicle screw fixation: a prospective 2-year longitudinal study using finite element analysis
title_full The effect of denosumab on pedicle screw fixation: a prospective 2-year longitudinal study using finite element analysis
title_fullStr The effect of denosumab on pedicle screw fixation: a prospective 2-year longitudinal study using finite element analysis
title_full_unstemmed The effect of denosumab on pedicle screw fixation: a prospective 2-year longitudinal study using finite element analysis
title_short The effect of denosumab on pedicle screw fixation: a prospective 2-year longitudinal study using finite element analysis
title_sort effect of denosumab on pedicle screw fixation: a prospective 2-year longitudinal study using finite element analysis
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7995779/
https://www.ncbi.nlm.nih.gov/pubmed/33771178
http://dx.doi.org/10.1186/s13018-021-02360-2
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