Atrophic femoral nonunion successfully treated with teriparatide

Abstract

Teriparatide is a synthetic polypeptide hormone that contains the 1-34 aminoacid fragment of the recombinant human parathyroid hormone. It has been approved for the treatment of postmenopausal women with osteoporosis who are at high risk for sustaining a fragility fracture. It has been shown that teriparatide also accelerates fracture healing by improving the biomechanical properties of the fracture callus, increasing endochondral ossification and bone remodeling in animal models. This effect has been observed in several case reports. Fracture healing disorders negatively affect the patient's quality of life and result in high healthcare costs, as a second surgery is required to stabilize the fracture and stimulate bone biology. Future biotechnologies that accelerate fracture healing may be useful tools. We present a case report of delayed union of a femoral fracture treated with teriparatide. She was diagnosed with right distal metaphyseal femoral fracture on total knee arthroplasty. She underwent surgery at our center consisting of ORIF with lateral femoral locking plate in October 2011. Radiologic controls at 5 and 7 months did not show any signs of healing. After 2 months of treatment with teriparatide, the X-ray showed the presence of bone bridges and a decreased gap between fragments and a different aspect of neoformed bone. After 3 months of treatment, healing was complete. Our case report seems to confirm the possible effect of TPTD as bone induction through a more rapid healing of fractures. The TPTD could have a potentially important role in treating some forms of nonunion and delay in consolidation. Thus, one could hypothesize the possibility of a medical treatment with TPTD both as a preventive way and also as a support to the synthesis in high risk of nonunion fractures and complexed fractures in osteoporotic bone.

Sternal instability in a hemodialysis patient with secondary hyperparathyroidism

“…Certainly, both high‐turnover and low‐turnover bone disease may contribute to the relatively high prevalence of fracture nonunion in HD patients. There are cases in the general population, in which PTH analogs were used successfully for the treatment of fracture nonunion in case of low‐turnover bone disease, whereas parathyroidectomy resolved this problem in case of high‐turnover bone disease due to primary hyperparathyroidism . It is likely that defect in the fracture healing process due to hyperparathyroidism contributed to sternal nonunion in the present case.…”

Combined Surgical And Medical Treatment For Periprosthetic Femoral Fractures Over A Stable Stem (Vancouver Type B1 And C): A Proposal Of A Therapeutic Algorithm To Reduce The Risk Of Nonunion.

“…Our initial experience on re-fractures [52,[83][84][85], the one with AFFs when intramedullary nailing is not possible (over a deformed bone or in "periprosthetic" AFFs) [51] and with proximal femur fractures in the elderly (in which we always do a metabolic study of the patient, and eventually proposed an antiosteoporotic pharmacological treatment together to the Bone metabolism Unit) and the review of Literature [47,[86][87][88], lead us to proposed a surgical aggressive and combined pharmacological treatment even to some rst-time PFFs.…”

“…Moreover, studies are present in the literature suggesting that Teriparatide can be usefull in fractures' and nonunions' management as well as for osteoporosis [47][48][49][50][51][52]. This drug works by stimulating osteoblasts and reducing osteoblast apoptosis, increasing callus formation, improving mechanical strength, and resulting in increased osteoblast life span.…”

Clinical and surgical approach of severe bone fragility fracture: clinical case of 4 fragility fracture in patient with heavy osteoporosis

“…In such cases the orthopaedic surgeon needs to formulate first a clinical osteoporotic pattern, than its treatment together with a surgery suitable choice, that has to take into consideration of the bone structural characteristics. All this in order to optimize the resources available for the fragility fractures treatment: pharmacological resources (anti osteoporotic drugs and adequate calcium and Vit D supplementation), surgical resources (specific osteoporotic bone fixation) and physical resources (use of osteoinductive capacity of magnetic fields) (17,18). In the case described one can note that fractures healing occurred thanks to both an improvement in surgical techniques and antiosteoporotic pharmacological support, in the specific case the Authors used strontium ranelate for its osteoinductive capacity.…”