title: Teriparatide Improves Fracture Healing and Early Functional Recovery in Treatment of Osteoporotic Intertrochanteric Fractures.
abstract: Osteoporotic intertrochanteric fractures result in serious health problems and decrease health-related quality of life (HRQoL). Faster time-to-union is important for early return to daily activities and reduction of complications. Teriparatide has been shown to accelerate fracture healing, but the literature is sparse on this topic. The aim of this study is to assess whether teriparatide accelerates fracture healing.Between 2008 and 2014, patients with osteoporotic intertrochanteric fractures who underwent surgical interventions were enrolled in this retrospective cohort study. Group 1 included patients who were not on any osteoporosis medication prior to fracture and who postoperatively received only calcium and vitamin D; patients in Group 2 were not on any osteoporosis medication prior to fracture, and received teriparatide and calcium and vitamin D postoperatively. Patients in Group 3 were those who were on alendronate prior to fracture and postfracture received teriparatide as well as calcium and vitamin D. Demographics, time-to-union, HRQoL (short-form health survey [SF]-12 physical component summary [PCS] and SF-12 mental component summary [MCS]), morbidities, mortalities, and radiographic and functional outcomes between groups were compared.A total of 189 patients were enrolled in this study. There were 83 patients in Group 1, 47 patients in Group 2, and 59 patients in Group 3. A significantly shorter time-to-union was found in the teriparatide-treated groups (mean, 13.6, 12.3, and 10.6 weeks, respectively [P = 0.002]). With regard to SF-12 PCS, the scores were significantly better in teriparatide-treated groups at 3 months (mean, 19, 28, and 29, respectively [P = 0.002]) and 6 months (mean, 28, 37, and 38, respectively [P = 0.008]). Similar inter-group differences were noted when comparing the pain scores, the ability to get around the house, the ability to get out of the house, and the ability to go shopping at 3 and 6 months. Complications and mortality were also markedly reduced in the teriparatide-treated groups.Postoperative use of teriparatide for 6 months appears to be an effective adjunct therapy in the treatment of patients with osteoporotic intertrochanteric fractures. However, because of the limited power of the study, a prospective, randomized, large-scale cohort study is still required for determining the efficacy of teriparatide.
authors.affiliation: From the Department of Orthopedic Surgery (T-WH, P-YC, S-JL, C-YL, K-CH, RW-WH) and Sports Medicine Center (RW-WH), Chang Gung Memorial Hospital, Chiayi, Taiwan; Department of Orthopedic Surgery, Kaohsiung Chang Gung Memorial Hospital, Taiwan (MSL); Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan (H-NS); Chang Gung University, Taoyuan, Taiwan (T-WH, K-CH, H-NS, MSL, RW-WH); and Po-Cheng Orthopedic Institute, Kaohsiung (W-JS), Taiwan.
authors.forename: Tsan-Wen
authors.initials: TW
authors.lastname: Huang
authors.forename: Po-Yao
authors.initials: PY
authors.lastname: Chuang
authors.forename: Shih-Jie
authors.initials: SJ
authors.lastname: Lin
authors.forename: Chien-Yin
authors.initials: CY
authors.lastname: Lee
authors.forename: Kuo-Chin
authors.initials: KC
authors.lastname: Huang
authors.forename: Hsin-Nung
authors.initials: HN
authors.lastname: Shih
authors.forename: Mel S
authors.initials: MS
authors.lastname: Lee
authors.forename: Robert Wen-Wei
authors.initials: RW
authors.lastname: Hsu
authors.forename: Wun-Jer
authors.initials: WJ
authors.lastname: Shen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019386:Alendronate / Q000627:therapeutic use; D050071:Bone Density Conservation Agents / Q000627:therapeutic use*; D002118:Calcium / Q000627:therapeutic use; D005260:Female; D017102:Fracture Healing / Q000187:drug effects*; D006620:Hip Fractures / Q000188:drug therapy* / Q000209:etiology / Q000601:surgery; D006801:Humans; D008297:Male; D010024:Osteoporosis / Q000150:complications / Q000188:drug therapy; D058866:Osteoporotic Fractures / Q000188:drug therapy* / Q000209:etiology / Q000601:surgery; D011184:Postoperative Period; D020127:Recovery of Function / Q000187:drug effects*; D012189:Retrospective Studies; D019379:Teriparatide / Q000627:therapeutic use*; D013997:Time Factors; D014807:Vitamin D / Q000627:therapeutic use; D014815:Vitamins / Q000627:therapeutic use
chemical_list: D050071:Bone Density Conservation Agents; D014815:Vitamins; D019379:Teriparatide; D014807:Vitamin D; D002118:Calcium; D019386:Alendronate