The Efficacy of Teriparatide in Improving Fracture Healing in Hip Fractures: A Systematic Review and Meta-Analysis

Abstract

Background. This systematic review and meta-analysis assessed the role of teriparatide in improving hip fracture healing and function to provide a clinical guide. Methods. The systematic literature review identified randomized controlled trials (RCTs) and controlled studies evaluating teriparatide for elderly hip fractures. A meta-analysis was performed using RevMan version 5.3. Results. This study included two RCTs and four retrospective studies comprising 607 patients, with 269 and 338 patients in the teriparatide and control groups, respectively. The quality of these six studies was moderate. Compared to the control group, teriparatide reduced the time to union (weighted mean difference WMD=−1.95; 95% confidence interval (CI): -3.23–-0.68; P=0.003) but did not improve the rate of fracture union at 3 months (odds ratio OR=1.46; 95% CI: 0.50–4.24; P=0.49) or 6 months (OR=0.89; 95% CI: 0.44–1.81; P=0.75). In addition, teriparatide did not decrease the complications, need for reoperation, mortality, rate of deformity after fracture healing, and subsequent fracture or improve hip function. Conclusions. The current limited evidence did not support that teriparatide improves fracture healing in hip fractures, due to study heterogeneity and various sources of biases. Further high-quality, large-sample trials are needed. This trial is registered with PROSPERO with registration number CRD42020152205.

The effect of osteoporosis and its treatment on fracture healing a systematic review of animal and clinical studies

“…A recent meta-analysis on the effect of teriparatide on fracture healing in hip fracture patient analysed all 2 RCTs and 4 retrospective studies on hip fracture patients that we identified. [88] Teriparatide was found not to affect union rate, due to study heterogeneity and various sources of biases the limited evidence found did not support the hypothesis that teriparatide improves fracture healing in hip fractures [88] . They included four studies performed in an osteoporotic fracture population 89 , 90 , 91 , 92 and two with an unknown osteoporosis status 93 , 94 .…”

“…Four remaining retrospective studies in hip fracture patients, were also analysed in the meta-analysis of Han et al [88] . Three out of four found a reduced time to union in the group of patients treated with teriparatide 89 , 90 , 91 , while one study did not find a difference in fracture healing time [92] .…”

Adherence to Anti-Osteoporotic Treatment and Clinical Implications after Hip Fracture: A Systematic Review

“…Most of the studies regarding teriparatide and hip fracture are related to secondary outcomes such as accelerated fracture healing and union, with less data regarding mortality or subsequent fractures [ 29 ]. The meta-analysis regarding the effect of teriparatide included in the review showed data from two clinical trials and three retrospective cohort studies [ 29 ], with a total of 607 patients. The model showed no significant effect on mortality or subsequent fracture risks [ 29 ].…”

“…The meta-analysis regarding the effect of teriparatide included in the review showed data from two clinical trials and three retrospective cohort studies [ 29 ], with a total of 607 patients. The model showed no significant effect on mortality or subsequent fracture risks [ 29 ]. The most important limitation is the lower heterogeneity between included studies, related to the inconsistencies between treatment doses and duration [ 29 ].…”

“…The model showed no significant effect on mortality or subsequent fracture risks [ 29 ]. The most important limitation is the lower heterogeneity between included studies, related to the inconsistencies between treatment doses and duration [ 29 ].…”