Bone Bridge Effect for the Treatment of Acute Osteoporotic Vertebral Compression Fractures: A Multistrategic Approach Using an Anabolic Agent

Abstract

Purpose: To determine the bone bridge effect (BBE) and compare treatment outcomes of different osteoporosis medications in patients with lumbar osteoporotic vertebral compression fractures (OVCF). Materials and Methods: This study followed 264 patients with lumbar OVCFs undergoing conservative treatment for more than 12 months. Patients were divided into four groups based on medication: denosumab monotherapy (group D), teriparatide and denosumab combination (group TDco), sequential romosozumab followed by denosumab (group RDse), and bisphosphonate mono-therapy (group B). Changes in bone mineral density (BMD), radiological parameters including BBE, and visual analog scale (VAS) scores were compared from injury to 1 year post-injury. Results: The 1-year BBE incidence was highest in groups treated with anabolic agents: group RDse (56.3%) and group TDco (51.8%). These rates were significantly higher than in group D (28.6%) and group B (21.1%). The annual BMD increase was significantly greater in group TDco (1.04) compared to the other groups (RDse: 0.63; D: 0.55; B: 0.35). VAS scores decreased significantly by the 3-month mark in anabolic agent groups and in patients with confirmed BBE, indicating rapid pain relief. Multivariate logistic regression analysis confirmed that anabolic agent groups (TDco and RDse) were significant independent predictors of BBE formation (odds ratio 2.717 and 3.472, respectively), even after adjusting for confounding variables such as initial BMD. Conclusion: Anabolic agents appeared to be associated with more BBE formation, greater BMD gains, and faster pain reduction compared to anti-resorptive agents. Therefore, treatment strategies using anabolic agents, such as those in groups TDco and RDse, maybe important considerations for treating patients with OVCFs.