Teriparatide as a systemic treatment for lower extremity nonunion fractures: a case series.

Abstract

OBJECTIVE:

To investigate the effect of teriparatide (parathyroid hormone [1-34]) on the healing of long bone nonunion fractures.

METHODS:

We performed a retrospective chart review of patients with fracture nonunion, aged 10 to 99 years who were treated with teriparatide at the Children's Hospital of Philadelphia or the Hospital of the University of Pennsylvania between November 2002 and January 2013. The primary endpoints were radiographic evidence of callus formation and fracture union, ability to bear weight without affected limb limp, and normal range of motion and strength.

RESULTS:

Six patients aged 19 to 64 years with tibial or femoral fractures that had not healed for 3 to 36 months were treated with teriparatide 20 μg/day. Accelerated healing of fracture nonunion was confirmed in 5 of 6 patients with time to complete union of 3 to 9 months. The shortest time to recovery was observed in younger patients without comorbidities. Treatment was well tolerated.

CONCLUSION:

Teriparatide is a promising treatment for nonunion fractures, but its response depends on associated comorbidities. The potential benefit of teriparatide as an adjunct to treat nonunion justifies randomized placebo-controlled trials to determine its efficacy and safety in broader populations.

• Authors: Edna E Mancilla, Jill L Brodsky, Samir Mehta, Robert J Pignolo, Michael A Levine
• Journal: Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists (Endocr Pract) Vol. 21 Issue 2 Pg. 136-42 (Feb 2015) ISSN: 1530-891X [Print] United States
• PMID: 25297667 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Teriparatide

Topics

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Child
• Female
• Femoral Fractures (drug therapy)
• Fracture Healing (drug effects)
• Fractures, Ununited (drug therapy)
• Humans
• Male
• Middle Aged
• Retrospective Studies
• Teriparatide (therapeutic use)
• Tibial Fractures (drug therapy)