title: Teriparatide as a systemic treatment for lower extremity nonunion fractures: a case series.
abstract: OBJECTIVE
  To investigate the effect of teriparatide (parathyroid hormone [1-34]) on the healing of long bone nonunion fractures.
  
  
  METHODS
  We performed a retrospective chart review of patients with fracture nonunion, aged 10 to 99 years who were treated with teriparatide at the Children's Hospital of Philadelphia or the Hospital of the University of Pennsylvania between November 2002 and January 2013. The primary endpoints were radiographic evidence of callus formation and fracture union, ability to bear weight without affected limb limp, and normal range of motion and strength.
  
  
  RESULTS
  Six patients aged 19 to 64 years with tibial or femoral fractures that had not healed for 3 to 36 months were treated with teriparatide 20 μg/day. Accelerated healing of fracture nonunion was confirmed in 5 of 6 patients with time to complete union of 3 to 9 months. The shortest time to recovery was observed in younger patients without comorbidities. Treatment was well tolerated.
  
  
  CONCLUSIONS
  Teriparatide is a promising treatment for nonunion fractures, but its response depends on associated comorbidities. The potential benefit of teriparatide as an adjunct to treat nonunion justifies randomized placebo-controlled trials to determine its efficacy and safety in broader populations.
authors.affiliation: Division of Endocrinology and Diabetes, The Children's Hospital of Philadelphia, Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Edna E
authors.initials: EE
authors.lastname: Mancilla
authors.affiliation: Division of Endocrinology and Diabetes, The Children's Hospital of Philadelphia, Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Jill L
authors.initials: JL
authors.lastname: Brodsky
authors.affiliation: Orthopaedic Trauma & Fracture Service, Hospital of the University of Pennsylvania Department of Orthopaedic Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Samir
authors.initials: S
authors.lastname: Mehta
authors.affiliation: Ralston-Penn Clinic for Osteoporosis & Related Bone Disorders, Center for FOP and Related Bone Disorders, Departments of Medicine & Orthopaedic Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Pignolo
authors.affiliation: Division of Endocrinology and Diabetes, The Children's Hospital of Philadelphia, Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Levine
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D005260:Female; D005264:Femoral Fractures / Q000188:drug therapy*; D017102:Fracture Healing / Q000187:drug effects; D005599:Fractures, Ununited / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D019379:Teriparatide / Q000627:therapeutic use*; D013978:Tibial Fractures / Q000188:drug therapy*
chemical_list: D019379:Teriparatide