title: Teriparatide may accelerate healing in delayed unions of type III odontoid fractures: a report of 3 cases.
abstract: METHODS
  Case Report.
  
  
  OBJECTIVE
  To report on the treatment of 3 cases of painful delayed unions of type III odontoid fractures with teriparatide.
  
  
  BACKGROUND
  Fractures of the C2 vertebra, also known as odontoid fractures, are an important subset of cervical spine fractures. Type III odontoid fractures pass through predominately cancellous bone of C2. Generally accepted treatment is external immobilization with either a rigid collar or a halo vest for 8 to 12 weeks. We report 3 patients who, despite external immobilization, developed painful delayed unions of type III odontoid fractures. Teriparatide is a novel anabolic drug therapy for osteoporosis. It has been shown to stimulate osteoblasts, enhance bone connectivity, increase endosteal cortical thickness, and improve bone mineral content. The drug is given through subcutaneous injection of 20 microg/d for between 6 weeks and 2 years. We treated these 3 patients with teriparatide. Each was informed that details of their case would be submitted for publication.
  
  
  METHODS
  Retrospective case analysis.
  
  
  RESULTS
  All 3 patients experienced both rapid clinical improvement and computed tomography evidence of fracture union.
  
  
  CONCLUSIONS
  These 3 cases represent relatively uncommon clinical scenarios in which type III odontoid fractures in osteoporotic women failed to unite with external immobilization over several months. The patients presented for follow-up with substantial, activity-limiting neck pain. All 3 were begun on teriparatide doses therapeutic for osteoporosis, and all 3 experienced both remarkable resolution of chronic neck pain and computed tomography-confirmed union of the fractures.
authors.affiliation: Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, Rochester, NY 14642, USA. Paul_Rubery@URMC.Rochester.edu
authors.forename: Paul T
authors.initials: PT
authors.lastname: Rubery
authors.forename: Susan V
authors.initials: SV
authors.lastname: Bukata
mesh_terms: D000369:Aged, 80 and over; D050071:Bone Density Conservation Agents / Q000008:administration & dosage*; D001861:Bone Regeneration / Q000187:drug effects* / Q000502:physiology; D004334:Drug Administration Schedule; D016267:External Fixators; D005260:Female; D006801:Humans; D007279:Injections, Subcutaneous; D019547:Neck Pain / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology; D009809:Odontoid Process / Q000000981:diagnostic imaging / Q000187:drug effects* / Q000473:pathology; D010024:Osteoporosis / Q000188:drug therapy / Q000503:physiopathology / Q000517:prevention & control; D012189:Retrospective Studies; D016103:Spinal Fractures / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000473:pathology; D019379:Teriparatide / Q000008:administration & dosage*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014945:Wound Healing / Q000187:drug effects* / Q000502:physiology
chemical_list: D050071:Bone Density Conservation Agents; D019379:Teriparatide