Role of Supplemental Teriparatide Therapy to Augment Functional and Radiological Outcomes in Osteoporotic Intertrochanteric Hip Fractures in the Elderly Population

Abstract

With improved life expectancy and ever-increasing geriatric population with concomitant osteoporosis, there is increase in osteoporotic intertrochanteric hip fractures. Even the best surgical advances fail to provide satisfactory and early results. As a result, researchers' focus has lately shifted to developing a more integrated approach that combines the pharmacotherapeutic capabilities of teriparatide, a recombinant version of human parathyroid hormone (1-34), a new anabolic drug that enhances bone mass and strength by promoting osteoblastic activity and hastens fracture union in both human and animals. We attempted to evaluate the therapeutic efficiency of teriparatide therapy on outcomes of surgically managed Intertrochanteric hip fractures in osteoporotic patients. A total of 31 patients with established osteoporosis and Intertrochanteric fractures were selected and divided into two groups, managed surgically with proximal femur nailing, and then prospectively compared with one group receiving teriparatide therapy in addition to standard treatment after taking necessary consent and allocation into two groups based on the preference of patients to take additional teriparatide or not after understanding the benefits and risks involved. We aimed to assess the functional and radiological effects of teriparatide on bone mineral density, the time taken for fracture union, and other fracture-related postoperative complications such as weight bearing and residual bone pain. All patients were followed up at 6, 12, and 24 weeks. Time to fracture union was significantly shortened, with considerable improvement in bone density and functional outcome in the teriparatide group. Varus collapse, the rate of migration of the helical blade, and shortening of the femoral neck were also significantly less in the study group. From the assembled data, we can safely assume that with early union rates with better functional improvement with additional advantage of increased bone mass, we favor supplemental teriparatide therapy in the management of osteoporotic patients with femoral intertrochanteric fractures to augment healing. Further studies with a larger sample size are required to support our observation.

Effectiveness of teriparatide in in improving healing rates and bone-turnover markers of osteoporotic hip fracture: a meta-analysis

“…As the heterogeneity I 2 value at 3 months was 71% (p=0.01), a sensitivity analysis was performed. After excluding one study 23 , the heterogeneity decreased significantly with I 2 value 34%, and it was 0% at 6 months. Subgroup analysis showed there were no significant difference in the fracture healing rate between the two groups at 3 months of treatment (RR: 1.03, 95% CI: 0.90-1.18, p=0.64) and 6 months of treatment (RR: 1.00, 95% CI: 0.95-1.05, p=0.97).…”

“…Also, 3(37.5%) RCTs used the random number table method 15-17, and 6(75%) RCTs used the random doubleblind grouping method [15][16][17][18][19][20] . Safety evaluation was reported in 7 studies [15][16][17][18][19]22,23 (Table 2). The risk of bias was noted (Figures 2-3), and the outcome measures were summarised (Table 3).…”