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Summary: In patients in the Direct Assessment of Nonvertebral Fractures in Community Experience (DANCE) observational study with and without a prior vertebral or hip fracture, the incidence of nonvertebral fractures was lower with >6 months of teriparatide treatment than during the first 6 months., Introduction: Clinical evidence on the effect of teriparatide in patients with prior fracture is limited. In the DANCE observational study, the incidence of nonvertebral fragility fractures (NVFX) decreased significantly in patients receiving teriparatide for >6 months (6-24 months) versus >0 to ≤6 months (reference period)., Methods: We performed a post hoc analysis to assess the effect of teriparatide 20 μg/day in patients who entered DANCE with prior vertebral or hip fractures. The incidence of patients experiencing a NVFX for four 6-month intervals during and after treatment was compared with the reference period., Results: Overall, 4085 patients received ≥1 dose of teriparatide. Of 3720 with sufficient data for efficacy analysis, 692 had prior vertebral fracture, including 179 with previous kyphoplasty/vertebroplasty; 290 had prior hip fracture. These patients were older, and those with prior vertebral fractures had more comorbid conditions at baseline than those without prior vertebral fractures. The incidence of patients experiencing NVFX declined over time in all patient groups. The fracture incidence rate declined 49 and 46%, respectively, in patients with and without prior vertebral fracture and was 63 and 46% lower in patients with previous kyphoplasty/vertebroplasty and without prior vertebral fracture. NVFX declined 43 and 48% in patients with and without prior hip fracture. The reduced incidence over time was consistent in the subgroups (all interaction p values >0.05). Patients with prior fracture were more likely to experience serious adverse events., Conclusion: The incidence of NVFX decreased over time in patients receiving teriparatide in DANCE regardless of prior fracture status.

Tyree D Williams,1– 3 Talia Adler,2,4 Lindsey Smokoff,2,4 Anmoldeep Kaur,2,5 Benjamin Rodriguez,2,3,6 Kavita Jyoti Prakash,6 Edib Redzematovic,2 Turner S Baker,2,3,7 Benjamin I Rapoport,2,3 Edward S Yoon,8 Douglas P Beall,9 Jonathan S Dordick,1 Reade A De Leacy3 1Biomedical Engineering, Rensselaer Polytechnic Institute, Troy, NY, USA; 2Sinai BioDesign, Mount Sinai Medical System, New York, NY, USA; 3Department of Neurosurgery, Mount Sinai Medical System, New York, NY, USA; 4Columbia University School of General Studies, New York, NY, USA; 5Department of Neuroscience, Smith College, Northampton, MA, USA; 6Icahn School of Medicine at Mount Sinai, New York, NY, USA; 7Department of Population Health Science & Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA; 8Hospital for Special Surgery, New York, NY, USA; 9Spine Fracture Institute, Oklahoma City, OK, USACorrespondence: Benjamin Rodriguez, Department of Neurosurgery, Mount Sinai Medical System, One Gustave L. Levy Place, Box 1136, New York, NY, USA, Tel +1 615 524-0211, Email tyree.williams@mssm.eduAbstract: Vertebral compression fractures (VCFs) are common in osteoporotic patients, with a frequency projected to increase alongside a growing geriatric population. VCFs often result in debilitating back pain and decreased mobility. Cement augmentation, a minimally invasive surgical technique, is widely used to stabilize fractures and restore vertebral height. Acrylic-based cements and calcium phosphate cements are currently the two primary fill materials utilized for these procedures. Despite their effectiveness, acrylic bone cements and calcium phosphate cements have been associated with various intraoperative and postoperative incidents impacting VCF treatment. Over the past decade, discoveries in the field of biomedical engineering and material science have shown advancements toward addressing these limitations. This narrative review aims to assess the potential pitfalls and barriers of the various types of bone cements.Keywords: osteoporosis, vertebral compression fractures, bone cement, vertebroplasty, kyphoplasty, vertebral augmentation