Teriparatide for treating delayed union and nonunion: A systematic review

Abstract

Introduction: Fracture nonunion remains a great challenge for orthopaedic surgeons. Approximately 5 e10% of bone fractures do not heal promptly, and require another surgical procedure. Previously, several small studies have found that teriparatide, a parathyroid hormone (PTH) analogue, has been found to induce union in those with delayed union and nonunion. However, to date, no systematic reviews regarding the use of teriparatide for delayed union and nonunion are available. The present review aims to investigate the safety and efficacy of teriparatide in delayed union and nonunion. Methods: Systematic literature search was performed in PubMed, ScienceDirect, and Google Scholar until September 26, 2019. We included studies involving adult patients (age >16 years) diagnosed with delayed union or nonunion fracture regardless of location (long bone, short bone, flat bone or irregular bone). The language was restricted to English and Indonesian. Outcomes that were recorded were fracture union and adverse events. Results: Initial search found 5416 abstract and titles. Of these, 20 articles consisting of 64 subjects were retrieved. Of these, 15 case reports, 4 case series, and one prospective study were included. All of the studies administered subcutaneous injection of teriparatide 20 mg/day with mean duration of 7.3 ± 1.5 weeks to 9.7 months. Sixty-one (95.3%) of 64 subjects developed complete union. The follow-up ranged from 3 to 24 months. No side effects occurred during the follow-up period.Conclusions: Limited evidence demonstrates that daily subcutaneous injection of teriparatide 20 mg is a potential new safe treatment for delayed union and nonunion with no side effects. We highly suggest the use of such drug, as it is highly effective and safe. However, further clinical studies are required to investigate its safety and efficacy.

Does Teriparatide Improve Fracture Union?: A Systematic Review

“…[47] Surgeons can be very frustrated when nonunion not allowing its healing even if revision is well-performed according to the principles (surgical restabilization and provision of biological https://doi.org/10.11005/jbm.2020.27.3.167 stimulation). [48,49] A 45-year-old man with femoral shaft fracture nonunion at which the original intramedullary nail was revised with internal fixation using an anatomical plate together with autogenous bone graft. However, reoperation again failed to heal the fracture in the next 12 months.…”

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.…”

“…Physiological PTH actions include stimulation of osteogenesis by direct effects on cells responsible of bone formation (osteoblasts) and indirectly by increasing intestinal absorption of calcium and increasing the renal tubular reabsorption of calcium and elimination of phosphate. Evidence is present in the Literature that Teriparatide can be useful in the treatment of nonunions, delayed unions and AFFs [47][48][49][50][51][52]. Also, in an animal model a combined administration of subcutaneous Teriparatide and systemic human mesenchymal stem cells showed a synergic positive effect on bone healing [93].…”

“…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.…”

Short-Term Teriparatide for Bone Marrow Edema Secondary to Complex Regional Pain Syndrome: Case Reports on Efficacy After Two Years of Follow-Up

“…Officially indicated for the treatment of postmenopausal or glucocorticoids-induced Open Access Case Report DOI: 10.7759/cureus.8119 osteoporosis, TPT may also increase bone mass in men with primary or hypogonadal osteoporosis, directly enhancing bone formation and quality, thus significantly reducing the risk of secondary fracture [8]. A first off-label use of TPT has been investigated for the treatment of aseptic bone non-unions with a good safety profile and promising preliminary result [9]. Moreover, it has been successfully applied in case of transient osteoporosis and osteonecrosis of the hip [10,11].…”