title: [Use of osteoanabolics in fracture nonunion].
abstract: BACKGROUND
  The treatment of fracture nonunion (pseudarthrosis) is often lengthy and debilitating for the patient. There are operative and conservative therapies available.
  
  
  OBJECTIVE
  Does the systemic use of osteoanabolic acting substances (osteoanabolics) lead to an acceleration of the delayed fracture healing and/or strengthening of the fracture? Which types of pseudarthrosis are suitable for this treatment option?
  
  
  METHODS
  A literature review was carried out focusing on the systemic anabolic therapy options for the treatment of delayed healing of fractures or pseudarthrosis. Additionally, our own case studies are presented.
  
  
  RESULTS
  Teriparatide and strontium ranelate have a positive effect on the healing of fractures in animal studies and in humans. There are also case studies on the use of both substances in delayed fracture healing or pseudarthrosis. The scientific knowledge regarding teriparatide is significantly more comprehensive. However, prospective randomized trials are lacking so far.
  
  
  CONCLUSIONS
  The systemic use of anabolics can be a therapeutic option, especially for biological reactive pseudarthrosis. However, these are off-label treatments and contraindications should be especially well heeded. Because of the numerous positive results, from the point of view of teriparatide treatment, a multicentric, prospective randomized study on the treatment of aseptic pseudarthrosis should be initiated.
authors.affiliation: Orthopädie & Osteologie, Dr. Becker Rhein-Sieg-Klinik, Höhenstr. 30, 51588, Nümbrecht, Deutschland. kpeters@dbkg.de.
authors.forename: K M
authors.initials: KM
authors.lastname: Peters
authors.affiliation: Orthopädie & Osteologie, Dr. Becker Rhein-Sieg-Klinik, Höhenstr. 30, 51588, Nümbrecht, Deutschland.
authors.forename: T
authors.initials: T
authors.lastname: Tuncel
mesh_terms: D000818:Animals; D050071:Bone Density Conservation Agents / Q000008:administration & dosage*; D019317:Evidence-Based Medicine; D017102:Fracture Healing / Q000187:drug effects / Q000502:physiology*; D017759:Fractures, Malunited / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000503:physiopathology*; D006801:Humans; D011859:Radiography; D019379:Teriparatide / Q000008:administration & dosage*; D013876:Thiophenes / Q000008:administration & dosage*; D016896:Treatment Outcome
chemical_list: D050071:Bone Density Conservation Agents; D013876:Thiophenes; C081587:strontium ranelate; D019379:Teriparatide
keywords: Osteogenesis; Pseudarthrosis; Strontium ranelate; Teriparatide; Treatment outcome