Teriparatide as a Candidate Therapy in Incomplete Spinal Cord Injury: Improving Both Bone and Neurological Function

Study Design: Narrative review. Objective: To evaluate the potential therapeutic role of teriparatide in skeletal deterioration and secondary neurological injury mechanisms in patients with incomplete spinal cord injury (SCI). Summary of Background Data: Incomplete SCI is associated with substantial neurological impairment and rapid bone loss. Secondary injury processes—such as oxidative stress and blood-spinal cord barrier (BSCB) disruption—further exacerbate functional decline. Current treatment strategies have limited ability to target these interconnected pathologic mechanisms. Teriparatide, an anabolic agent approved for osteoporosis, has demonstrated emerging effects beyond those of bone metabolism, suggesting its possible utility in SCI. Methods: A comprehensive review of preclinical and clinical studies was conducted to assess the effects of teriparatide on bone mineral density, BSCB integrity, oxidative stress modulation, and related neuroprotective pathways in SCI. Results: Evidence shows that teriparatide enhances bone mineral density, particularly in trabecular-rich regions that are prone to accelerated loss after SCI. Preclinical findings indicate improved BSCB stability, associated with increased angiopoietin-1 expression and reduced MMP-9 activity. The activation of the Nrf2 pathway suggests additional antioxidant and neuroprotective effects. Collectively, these data support a multifaceted therapeutic profile relevant to both skeletal and secondary neurological complications in patients with incomplete SCI. Conclusions: Teriparatide exhibits promising multi-mechanistic effects that may benefit patients with incomplete SCI by improving bone regeneration and mitigating secondary injury. Additional controlled studies are needed to clarify its clinical efficacy and define its role in promoting both skeletal and neurological recovery.