DOI: http://dx.doi.org/10.18203/issn.2455-4510.IntJResOrthop20172892

Teriparatide treatment in non-uniting fracture: a case report

Sujoy Kundu

Abstract


Impaired healing of fractures delays the rehabilitation process, which in turn impacts quality of life. The associated costs cause an economic burden to both the society and the patients. Till date, no systemic treatment is approved for fracture healing. Teriparatide is a synthetic polypeptide hormone consisting of the 1–34 fragment of human parathyroid hormone. Apart from its recognized indication of osteoporosis, there is a growing body of evidence suggesting its ability to accelerate fracture healing and heal non-unions. The purpose of this case report is to elucidate the Indian experience of 5 cases of use of Teriparatide for fracture healing - delayed unions and non-unions and in the setting of osteoporotic fracture. The primary observation of our case report depicts that teriparatide is a viable therapy not only to treat osteoporosis but also to accelerate fracture healing. Teriparatide therapy accelerates healing, which allows patients to return to normal life and work faster, optimizes medical resource utilization, reduces chances for future second surgery, requirement of bone graft and overall chronic morbidity associated with long-term treatment. The advantages of teriparatide therapy are that it can be prescribed in any types of fractures, including those that will be treated non-surgically; it can be commenced at any time, and can be applied through the entire healing period. Our observations are in line with other studies showing the effects of Teriparatide on delayed union and non-unions in human subjects.


Keywords


Teriparatide, Fracture healing, Non union, Anabolic therapy

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References


Kraenzlin ME, Meier C. Parathyroid hormone analogues in the treatment of osteoporosis. Nature Reviews Endocrinology. 2011;7(11):647–56.

Neer RM, Arnaud CD, Zanchetta JR, Prince R, Gaich GA, Reginster JY, et al. Effect of parathyroid hormone (1-34) on fractures and bone mineral density in postmenopausal women with osteoporosis. N Engl J Med. 2001;344(19):1434-41.

Lindsay R, Scheele WH, Neer R, Pohl G, Adami S, Mautalen C, et al. Sustained vertebral fracture risk reduction after withdrawal of teriparatide in postmenopausal women with osteoporosis. Arch Intern Med. 2004;164(18):2024-30.

Peichl P, Holzer LA, Maier R, Holzer G. Parathyroid hormone 1-84 accelerates fracture-healing in pubic bones of elderly osteoporotic women. J Bone Joint Surg Am. 2011;93:1583–7.

Bukata SV, Puzas JE. Orthopedic uses of teriparatide. Curr Osteoporos Rep. 2010;8:28–33.

Aspenberg P, Genant HK, Johansson T, Nino AJ, See K, Krohn K, et al. Teriparatide for acceleration of fracture repair in humans: a prospective, randomized, double-blind study of 102 postmenopausal women with distal radial fractures. J Bone Miner Res. 2010;25:404–14.

Resmini G, Iolascon G. 79-year-old post-menopausal woman with humerus fracture during teriparatide treatment. Aging Clin Exp Res. 2007;19:30-1.

Chintamaneni S, Finzel K, Gruber BL. Successful treatment of sternal fracture nonunion with teriparatide. Osteoporos Int. 2010;21:1059–63.

Rubery PT, Bukata SV. Teriparatide may accelerate healing in delayed unions of type III odontoid fractures: a report of 3 cases. J Spinal Disord Tech. 2010;23:151–5.

Lou S, Lv H, Wang G, Zhang L, Li M, Li Z, et al. The Effect of Teriparatide on Fracture Healing of Osteoporotic Patients: A Meta-Analysis of Randomized Controlled Trials. Biomed Res Int. 2016;2016:6040379.