Effect of teriparatide in fracture healing of intertrochanteric fracture: a prospective study

Authors

  • Sanjeev K. Singhal Department of Orthopaedics, Maharaja Agrasen Hospital, Punjabi Bagh, Delhi, India
  • Naresh Aggarwal Department of Orthopaedics, Maharaja Agrasen Hospital, Punjabi Bagh, Delhi, India
  • Ajay Sharma Department of Orthopaedics, Maharaja Agrasen Hospital, Punjabi Bagh, Delhi, India

DOI:

https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20184386

Keywords:

Teriparatide, Fracture healing, Intertrochanteric fracture

Abstract

Background: Intertrochanteric fracture is a relatively common and serious medical issue in geriatric trauma result in serious health problems and decrease health related quality of life. Faster time-to-union is important for early return to daily activities and reduction of complications. Teriparatide has been shown to accelerate fracture-healing. The purpose of the present prospective, randomized, controlled study was to evaluate the effect of teriparatide on the course of intertrochanteric fracture-healing.

Methods: Forty patients of intertrochanteric fractures who underwent surgical intervention between June 2016 and May 2017 were enrolled in this prospective study and followed for minimum of six months. Group A included patients who received only calcium supplementation; patients in Group B received teriparatide along with calcium supplementation postoperatively.

Results: The mean time to fracture healing was between 8-12 weeks for the treatment group, compared with 12-16 weeks for the control group. There was also significant effectiveness with regards to Parker and Palmer mobility score at 6 months.

Conclusions: Postoperative use of teriparatide for 6 months appears to be an effective adjunct therapy in the treatment of patients with intertrochanteric fractures. However, because of the limited power of the study a large-scale cohort study is still required for determining the efficacy of teriparatide.

Author Biography

Sanjeev K. Singhal, Department of Orthopaedics, Maharaja Agrasen Hospital, Punjabi Bagh, Delhi, India

SENIOR CONSULTANT

DEPARTMENT OF ORTHOPAEDICS

References

Brauer CA, Coca-Perraillon M, Cutler DM. Incidence and mortality of hip fractures in the United States. JAMA. 2009;302:1573–9.

Shen SH, Huang KC, Tsai YH. Risk analysis for second hip fracture in patients after hip fracture surgery: a nationwide population-based study. J Am Med Dir Assoc. 2014;15:725–31.

Chen IJ, Chiang CY, Li YH. Nationwide cohort study of hip fractures: time trends in the incidence rates and projections up to 2035. Osteoporos Int. 2015;26:681–8.

Frost SA, Nguyen ND, CenterJR, Eisman JA, and Nguyen TV. Excess mortality attributable to hip-fracture: a relative survival analysis. Bone. 2013;56(1):23-9.

Wang CB, Lin CFJ, Liang WM. Excess mortality after hip fracture among the elderly in Taiwan: a nationwide population-based cohort study. Bone. 2013;56(1):147-53.

Gehrig LMB, Lane JM, O'Connor MI. Osteoporosis: management and treatment strategies for orthopaedic surgeons. Instruct Course Lect. 2009;58:817-32.

Schmidt AH, Braman JP, Duwelius PJ, McKee MD. Geriatric trauma: the role of immediate arthroplasty. J Bone Joint Surg Am. 2013;95(24):2030-9.

Chiu MH, Hwang HF, Lee HD. Effect of fracture type on health-related quality of life among older women in Taiwan. Arch Phys Med Rehabil. 2012;93:512–9.

Vergara I, Vrotsou K, Orive M. Factors related to functional prognosis in elderly patients after accidental hip fractures: a prospective cohort study. BMC Geriatr. 2014;14:124–32.

Orive M, Aguirre U, García-Gutiérrez S. Changes in health-related quality of life and activities of daily living after hip fracture because of a fall in elderly patients: a prospective cohort study. Int J Clin Pract. 2015;69:491–500.

Koval KJ, Cantu RV. Intertrochanteric fractures. In: Bucholz RW, Heckman JD, Court-Brown CM, editors. Rockwood and Green's fractures in adults. 6th Ed. Vol. 2. Philadelphia: Lippincott Williams and Wilkins. 2006:1793–825.

Lee PC, Hsieh PH, Chou YC, Wu CC, and Chen WJ. Dynamic hip screws for unstable intertrochanteric fractures in elderly patients—encouraging results with a cement augmentation technique. J Trauma-Inj Infec Crit Care. 2010;68(4):954-64.

Gardner MJ, Lorich DG, Lane JM. Osteoporotic femoral neck fractures: management and current controversies. Instructional Course Lectures. 2004;53:427-39.

Lorich DG, Geller DS, Nielson JH. Osteoporotic pertrochanteric hip fractures: management and current controversies. Instructional Course Lectures. 2004;53:441-54.

Eriksen EF, Keaveny TM, Gallagher ER. Literature review: the effects of teriparatide therapy at the hip in patients with osteoporosis. Bone. 2014;67:246–56.

Zhang D, Potty A, Vyas P. The role of recombinant PTH in human fracture healing: a systematic review. J Orthop Trauma. 2014;28:57–62.

Kleerekoper M, Greenspan SL, Lewiecki EM. Assessing the effects of teriparatide treatment on bone mineral density, bone microarchitecture, and bone strength. J Bone Joint Surg Am. 2014;96(11):90.

Mancilla EE, Brodsky JL, Mehta S. Teriparatide as a systemic treatment for lower extremity nonunion fractures: a case series. Endocr Pract. 2015;21:136–42.

Borges JL, Freitas A, Bilezikian JP. Accelerated fracture healing with teriparatide. Arq Bras Endocrinol Metabol. 2013;57:153–6.

Aspenberg P, Genant HK, Johansson T. 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.

Bashutski JD, Eber RM, Kinney JS. Teriparatide and osseous regeneration in the oral cavity. N Engl J Med. 2010;363:2396–405.

La Valle. Fractures of Hip. In Campbellis Operative Orthopaedics. 10th Edition (by Canale ST). Mosby publication. 2003;3:2873-938.

Singh CAK, Thong G, Laloo N: Management of Trochanteric Fractures. Indian J Orthop. 2006;40(2):100-2.

Evans EM. Trochanteric Fractures: A Review of 110 Cases treated by Nail- Plate Fixation. J Bone Joint Surg Br. 1951;33:192-204.

Oi Brien RM, Shy JC, Bublis NJ: Internal Fixation of Trochanteric Fractures of the Femur: Report of 103 Consecutive Cases. J Bone Joint Surg Am. 1946;28:791-7.

Yu CT, Wu JK, Chang CC, Chen CL, Wei JC. Early callus formation in human hip fracture treated with internal fixation and teriparatide. J Rheumatol. 2008;35:2082-3.

Gardenbroek Tjibbe. J, Segers Michiel JM, Simmermacher RKJ, Hammacher ER. The Proximal Femur Nail Antirotation: An Identifiable Improvement in the Treatment of Unstable Pertrochanteric Fractures. J Trauma. 2011;71:169-74.

Simmermacher RKJ, Ljungqvistb J, Bail CH et al. The new proximal femoral nail antirotation (PFNAW) in daily practice: Result of a multicentre clinical study. Injury, Int. J. Care Injured. 2008;39:932-9.

Huang TW, Yang TY, Huang KC, Peng KT, Lee MS et al. Effect of Teriparatide on Unstable Pertrochanteric Fractures. BioMed Res Int. 2015;2015:8.

Lou S, Houchen LV, Wang G, Zhang L et al. The Effect of Teriparatide on Fracture Healing of Osteoporotic Patients: A Meta-Analysis of Randomized Controlled Trials. BioMed Res Int. 2016;2016:1-10.

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Published

2018-10-24

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Original Research Articles