In Italy the osteoporosis cause approximately 250000 fracture/year. A useful aid in the treatment of this pathology comes from the Teriparatide, a synthetic form of the natural human parathyroid hormone, that stimulates the formation of new bone by increasing the number and action of bone-forming cells, unlike estrogen and bisphosphonate which are only able in slowing or stopping bone loss by blocking the action of osteoclasts. The Authors presents theirs first results after treatment with 20 mcg per day of Forsteo (Ely Lilly), trade name of the teriparatide, along with calcium (1000mg) and vitamin D (400UI) supplementation, for the previewed maximum period of 18 months, in women older than 65 years with unsatisfactory bisphosphonate treatment, T-score equal or inferior to −4, multiple vertebral osteoporotic fractures and one or more age-independent factors risk like: BMI< 19 kg/m2, maternal familiarity with neck-femoral fractures before 65 years old, premature menopause, conditions associated with the extended immobility. The treatment induced in all patients an increase of Ca plasmatic concentrations for 16–24 hours with a maximum peak in 4–6 hours. Condition like hypercalcemia, severe renal insufficiency, renal calculosis, hyperpara-thyroidism, Paget, alkaline hyperphosphatasaemia and previous therapy radiating are the main parameter of exclusion from the treatment.

B and C vertebral fractures types sec. Magherl have univocal indication to the surgery even if are in discussion both type and number of approaches than the characteristics of the osteosynthesis. About A type, instead, is debated if the treatment must be conservative or surgical. With the acquired experience in vertebro/kyphoplasty for the treatment of metastatic osteolytic or ostheoporotic fractures, Verlaan et al, in 2002, emphasized the possibility to use the kyphoplasty, in association to posterior stabilization, for treatment of traumatic toraco-lumbar A1-A2-A3 fractures, in order to reinforce the front column and to increase the vertebral body resistance. This idea, the experience of the kyphoplasty, the sophisticated B-Twin Expandable Spinal System mechanism, initially studied like intersomatic cage, are the base of a our technique for the treatment of great part of A type vertebral fractures.

The expansion of B-twin, introduced with transpe-duncolar approach, raise the plate reducing the fracture and creating an intraspongy space in which is possible to inject the cement at low pressure. We apply this technique approximately from one year, even if still experimental, without any cement complications or vertebral late sinking evidenced although we have always authorized the premature and not protected walking.