Abstract
CONTEXT: Cervical fusion outcomes are influenced by bone quality, with osteopenia increasing the risk of implant failure and revision surgery. The impact of teriparatide in this population remains unclear. AIMS: The aim of this study was to investigate the association between teriparatide use and 90-day medical complications, 2-year surgical complications, and hospital readmissions in this population. SETTINGS AND DESIGN: A retrospective cohort analysis using the PearlDiver Mariner database from 2010 to 2022. SUBJECTS AND METHODS: Patients undergoing cervical fusion were stratified by teriparatide use. Propensity score matching (1:5) was performed based on age, gender, Elixhauser Comorbidity Index, obesity, and bisphosphonate use. Primary outcomes included 90-day medical complications, 2-year surgical complications, surgical revisions, and hospital readmissions. STATISTICAL ANALYSIS USED: Logistic regression models were used to calculate odds ratios (ORs) with a Bonferroni-corrected significance level of P < 0.004. RESULTS: Ninety-eight teriparatide-treated patients were matched to 487 controls. Teriparatide use was significantly associated with higher rates of 2-year implant failure (4.1% vs. 1.0%, P = 0.003) and surgical revisions (54.1% vs. 4.7%, P < 0.001). Logistic regression demonstrated increased odds of 2-year implant failure (OR 6.63, 95% confidence interval [CI]: 1.93-23.78, P = 0.002) and surgical revisions (OR 27.83, 95% CI: 15.34-52.58, P < 0.001) in the teriparatide group. No differences were observed in 90-day medical complications or readmission rates (P > 0.004). CONCLUSIONS: Teriparatide use in osteopenic patients undergoing cervical fusion is associated with increased risks of 2-year implant failure and surgical revisions. These findings suggest that while teriparatide improves bone quality, its efficacy may be limited in this population. Future research should explore tailored interventions to optimize surgical outcomes in osteopenic patients.