Effects Of Treatment Strategies In Postmenopausal Females With Osteo-Porotic Vertebral Fracture

Purpose:1.To design four treatment schemes for osteoporotic vertebral fractures,including Teriparatide(TPTD),Vertebroplasty(PVP)plus alendronate,Teriparatide plus Vertebroplasty(TPTD+PVP),alendronate plus analgesics,evaluate from multiple dimensions of effectiveness,safety and economy in order to propose optimal and alternative plans for the treatment of osteoporotic vertebral fractures.2.To compare the therapeutic effects ofTeriparatide(TPTD)and Vertebroplast y(PVP)plus alendronate on pain relief,quality of life and cost-effectiveness in postmenopausal females with acute osteoporotic vertebral compression fractures,and aim to evaluate the utility of this new conservative treatment strategy.3.Long-term(one year)observation of the four treatment schemes for osteoporotic vertebral fracture related to the quality of life,bone density and fracture re-occurrence.Methods:1.This investigation represents a real-world prospective cohort study,where 120 postmenopausal women(?55 years old)with osteoporotic vertebral compression fractures,were equally assigned to a TPTD conservative group,PVP plus alendronate group,TPTD plus PVP group,and alendronate plus analgesics group based on the patient's choice.Patients in TPTD group will receive teriparatide(20?g,s.c.,once daily),while patients in alendronate plus analgesics group will receive oral oral analgesics(one pill,p.o.,When back pain is unbearable)and alendronate sodium(70 mg,p.o.,once weekly).In PVP plus alendronate group and TPTD plus PVP group,patients will take TPTD(20 ?g,s.c.,once daily)or alendronate(70 mg,p.o.,once weekly)after undergo vertebroplasty.Back pain(ODI),the Oswestry Disability Index(ODI),the health survey(SF-36)were regularly conducted at 0-week,1-week,1-month,3-month,6-month,12-month,1 8-month and 24-months after treatment to evaluate clinical effects and satisfaction.X-ray were regularly measured at 3-,6-,12-,18-and 24-months post-treatment.The medical expenses were regularly measured at 3-,12-,and 24-months post-treatment.MRI was measured at 3-and 6-months.BMD and the fracture recurrence rate were calculated every 12 months.Then the clinical effects of each group were compared to explore the feasibility of the four treatment plans.2.We merely analyzed the effects of TPTD conservative group and PVP plus alendronate group at the end of the third month post-treatment.3.We analyzed the clinical effects of four treatment schemes for osteoporotic vertebral compression fracture at the end of the twelfth month post-treatment.Results:2.Both treatments with TPTD and PVP significantly and similarly improved the patients' health quality,with reduced visual analogue and ODI scores at the end of the first and third months.PVP was more effective in reducing pain at the early time point(1 week,p<0.05).24 of 27 patients who were rescanned with magnetic resonance imaging in the TPTD group showed bone healing.The mid-vertebral height was increased by PVP(p<0.05)but not by TPTD.The cost of TPTD treatment was lower than the cost for PVP treatment(p<0.05).3.Four treatment options could similarly improve the patients' health quality at 3-month,6-month and 12-months after treatment,extraordinary,in TPTD plus PVP group.Compared with PVP plus alendronate,TPTD was more effective in improving quality of life at 12 months,but these differences did not reach statistical significance(P>0.05).Increment of BMD in TPTD group was even greater than PVP plus alendronate group at 12 months(p<0.05).The cost of TPTD+PVP treatment was the highest,and there was a statistical difference compared with the other three groups(p<0.05).Conclusion:1.The trial will provide much clinical evidence on effects of four treatment schemes,including TPTD,PVP+alendronate,TPTD+PVP,alendronate+analgesic,in osteoporotic vertebral fracture,which are relevant for the management of osteoporotic vertebral fracture.2.Teriparatide conservative treatment obtained similar therapeutic effects but cost less than PVP in terms of treating osteoporotic vertebral compression fracture.3.For patients with osteoporotic vertebral compression fractures,TPTD has better clinical effects than PVP surgery,and greater increase in BMD than alendronate,but the medical cost is less than TPTD+PVP group.Evaluation from multiple dimensions of effectiveness,safety and economy,TPTD could be considered as the primary treatment for compression fracture of osteoporotic fracture.