Role of Teriperatide in Osteoporotic Intertrochanteric Femoral Fracture: a randomized controlled experimental study

Abstract

Background: Despite recent advances in fracture fixation techniques, achieving favorable outcomes in osteoporotic intertrochanteric fractures not only by reducing the fracture site but also by ensuring long-term reduction is still difficult for surgeons. Consequently, the interest of researchers has shifted toward establishing a holistic approach for managing such injuries. Teriparatide, a recombinant form of human parathyroid hormone, is a novel drug that has been proven to hasten fracture healing in both animals and humans. We attempted to evaluate the influence of teriparatide therapy in surgically fixed osteoporotic intertrochanteric femur fractures and provide the groundwork for further research in this area. Methods: A total of 50 patients with established osteoporosis and intertrochanteric fractures were selected and divided into two groups: those who were managed surgically with proximal femur nailing and those who were prospectively compared. One group received teriparatide therapy in addition to standard treatment after providing the necessary consent, and the other group received calcium supplements alone. The results of both groups were prospectively compared. We investigated the effects of teriparatide on the time to fracture union, bone mineral density (BMD), bone turnover marker (BTM) level and other fracture-related postoperative complications. Radiological union was assessed via the Radiographic Union Score for Hip (RUSH). Results: All patients were followed up for 6 months, at which time all the fractures were united. However, in the teriparatide group, the time to fracture union significantly decreased by approximately 2 weeks, and the improvements in BMD and radiographic union were significantly greater. Conclusion: Our prospective study revealed that early union and a significant increase in the number of BMD tips favor teriparatide therapy in osteoporotic patients with intertrochanteric femur fractures. However, well-designed clinical trials conducted in a similar vein are needed to support our claim. Trial Registration: UMIN Clinical Trials Registry, UMIN000055856. Registered on 16-October-2024 – Retrospectively registered https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000063836