Association of Perioperative Teriparatide Use with Postoperative Complications in Spinal Fusion Surgery: A Systematic Review and Meta-Analysis

Background/Objectives: Teriparatide, a recombinant form of parathyroid hormone used for the treatment of osteoporosis, has also been investigated in patients undergoing spinal fusion surgery. The aim of this study was to evaluate the association between perioperative teriparatide use and postoperative complications after spinal fusion surgery through a meta-analysis of randomized controlled trials (RCTs) and observational studies. Methods: Systematic searches were conducted across PubMed, EMBASE, Cochrane Library, and Scopus for RCTs and observational studies that compared surgical outcomes in spinal instrumentation procedures with and without teriparatide. The primary pooled outcome was proximal junctional kyphosis (PJK). Secondary outcomes were radiographic nonunion, mechanical complications, reoperation rate, and incidence of new vertebral fractures. Meta-analyses were performed using Mantel–Haenszel models. Results: A total of 20 studies comprising 2543 patients with degenerative lumbar disease, adult spinal deformity, or osteoporotic vertebral fracture were included. Perioperative teriparatide use was associated with a lower incidence of PJK (Risk Ratio [RR] 0.40, 95% confidence interval [CI] 0.22–0.75, p = 0.004) and radiographic nonunion both on a per-patient basis (RR 0.66, 95% CI 0.47–0.93, p = 0.02) and on a per-level basis (RR 0.55, 95% CI 0.37–0.82, p = 0.004). Although there were no statistically significant differences in mechanical complications (RR 0.75, 95% CI 0.54–1.04, p = 0.08), reoperation rate (RR 0.76, 95% CI 0.53–1.08, p = 0.13), and new vertebral fractures (RR 0.60, 95% CI 0.31–1.17, p = 0.13), these outcomes numerically favored teriparatide. Conclusions: Perioperative teriparatide use was associated with lower rates of PJK and radiographic nonunion after spinal fusion surgery. However, the included studies were heterogeneous, and evidence for mechanical complications, reoperation, and new vertebral fractures remains limited.