OBJECT:
The object of this study was to examine the efficacy of preoperative teriparatide treatment for increasing the insertional torque of pediclescrews during fusion surgery in postmenopausal women with osteoporosis.

METHODS:
Fusion surgery for the thoracic and/or lumbar spine was performed in 29 postmenopausal women with osteoporosis aged 65-82 years (mean 72.2 years). The patients were divided into 2 groups based on whether they were treated with teriparatide (n = 13) or not (n = 16) before thesurgery. In the teriparatide-treated group, patients received preoperative teriparatide therapy as either a daily (20 μg/day, n = 7) or a weekly (56.5 μg/week, n = 6) injection for a mean of 61.4 days and a minimum of 31 days. During surgery, the insertional torque was measured in 212 screwsinserted from T-7 to L-5 and compared between the 2 groups. The correlation between the insertional torque and the duration of preoperativeteriparatide treatment was also investigated.

RESULTS:
The mean insertional torque value in the teriparatide group was 1.28 ± 0.42 Nm, which was significantly higher than in the control group (1.08 ± 0.52 Nm, p < 0.01). There was no significant difference between the daily and the weekly teriparatide groups with respect to mean insertionaltorque value (1.34 ± 0.50 Nm and 1.18 ± 0.43 Nm, respectively, p = 0.07). There was negligible correlation between insertional torque and duration of preoperative teriparatide treatment (r(2) = 0.05, p < 0.01).

CONCLUSIONS:
Teriparatide injections beginning at least 1 month prior to surgery were effective in increasing the insertional torque of pediclescrews during surgery in patients with postmenopausal osteoporosis. Preoperative teriparatide treatment might be an option for maximizing the purchase of the pedicle screws to the bone at the time of fusion surgery.
KEYWORDS: BMD=bone mineral density; PINP=procollagen Type I N-propeptide; PTH=parathyroid hormone; fusion surgery; insertional torque;osteoporosis; pedicle screw; technique; teriparatide