Assessment of the Efficacy of Bisphosphonates and Teriparatide Treatment on Lumbar Spine Fusion Surgery Outcomes

Abstract

Objective: To compare the efficacy of bisphosphonate and teriparatide therapy in improving radiological fusion and clinical outcomes among patients undergoing lumbar spine fusion surgery.

Methods: A comparative cohort study was conducted at Bahria International Hospital Rawalpindi Pakistan from January 2026 to June 2026. Ninety patients undergoing instrumented lumbar spinal fusion surgery were included. Forty-five patients received teriparatide and 45 patients received bisphosphonate therapy. Radiological fusion, postoperative pain, functional disability and postoperative mechanical complications were evaluated. Multivariable logistic regression was used to identify independent predictors of successful fusion.

Results: Fusion at three months was observed in 53.3% of the teriparatide group and 28.9% of the bisphosphonate group. At six months, fusion was achieved in 86.7% and 64.4% respectively. Mean time to fusion was shorter with teriparatide. Greater reductions in visual analogue scale and Oswestry Disability Index scores were also observed with teriparatide. Mechanical complications occurred in 13.3% of patients receiving teriparatide compared with 35.6% receiving bisphosphonates. Teriparatide remained independently associated with successful lumbar spinal fusion.

Conclusion: Teriparatide was associated with faster fusion, better functional recovery and fewer mechanical complications than bisphosphonate therapy following lumbar spinal fusion surgery.