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Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Jul 18, 2015; 6(6): 457-461
Published online Jul 18, 2015. doi: 10.5312/wjo.v6.i6.457
Use of Teriparatide to improve fracture healing: What is the evidence?
Satish Babu, Nemandra A Sandiford, Mark Vrahas
Satish Babu, Core Surgical Trainee, St. George’s Hospital, London SW17 0QT, United Kingdom
Nemandra A Sandiford, Lower Limb and Tumor Reconstruction Fellow, University of British Columbia, Vancouver V5Z 1M9, British Columbia, Canada
Mark Vrahas, Orthopaedic Trauma Service, Massachusetts General Hospital, Boston, MA 02114, United States
Author contributions: All authors contributed to this manuscript.
Conflict-of-interest statement: We, the authors of this scientific paper, do hereby state that we have no conflicts of interest to declare.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Nemandra A Sandiford, FRCS (Trauma and Orthopaedics), Lower Limb and Tumor Reconstruction Fellow, University of British Columbia, 2329 West Mall, Vancouver V5Z 1M9, British Columbia, Canada. nemsandiford@hotmail.com
Telephone: +1-208-3069032
Received: February 12, 2015
Peer-review started: February 12, 2015
First decision: April 10, 2015
Revised: May 2, 2015
Accepted: June 1, 2015
Article in press: June 2, 2015
Published online: July 18, 2015
Processing time: 152 Days and 8.9 Hours
Abstract

Teriparatide is a recombinant form of the biologically active component of Parathyroid hormone. It has been shown to increase bone mass and prevent fractures in osteoporotic bone. It is licensed by the Food and Drug Administration for the treatment of Osteoporosis. Over the last decade, a growing body of evidence has accumulated suggesting a role for Teriparatide in the management of fractures. Studies in both normal and delayed healing models have shown improvement in callus volume and mineralisation, bone mineral content, rate of successful union and strength at fracture sites. However most of these results have been derived from animal studies. The majority of this research on humans has comprised low level evidence, with few randomised controlled trials, many case reports and case series. Nevertheless, the results from these studies seem to support research from animal models. This has led to a growing number of clinicians using Teriparatide “off license” to treat fractures and non-unions in their patients. This review presents a critical appraisal of the current evidence supporting the use of Teriparatide for fracture healing, delayed unions and non unions and in the setting of osteoporotic fractures, the studies producing this evidence and their transferability to human beings.

Keywords: Teriparatide; Fractures; Healing; Bone; Osteoporosis

Core tip: Teriparatide contains the biologically active component of Parathyroid Hormone. It is utilised in osteoporosis for its ability to increase bone mass and prevent fractures. Research suggests Teriparatide may improve callus volume, callus mineralisation, bone mineral content and successful union. However most research come from animal models. Human research, whilst supporting Teriparatide use, mostly comprises low level evidence such as case series. Currently many United States physicians use Teriparatide “off license” for fractures and non-unions. We suggest more, well designed, human randomised controlled trials are required before Teriparatide can become a mainstream option in the conservative management of fractures and non-unions.