title: Adjuvant Teriparatide Therapy for Surgical Treatment of Femoral Fractures; Does It Work?
abstract: OBJECTIVE
  Atypical femoral fracture (AFF), periprosthetic femoral fracture (PPFF) and femoral nonunion (FNU) are recalcitrant challenges for orthopedic surgeons. Teriparatide (TPTD) had been demonstrated to have anabolic effects on bone in various studies. We postulated that adjuvant TPTD after operation would enhance biologic stimulation for bone formation. We investigated (1) whether the adjuvant TPTD could achieve satisfactory union rate of surgically challenging cases such as displaced AFF, PPFF and FNU; (2) whether the adjuvant TPTD could promote development of abundant callus after surgical fixation; (3) whether the adjuvant TPTD had medically serious adverse effects.
  
  
  METHODS
  Thirteen patients who agreed to off label use of TPTD in combination of operation were included in this retrospective case series. Median patients' age was 68.7 years, and there were three male and ten female patients. Their diagnoses were nonunion in six patients and acute fracture in seven. Medical records and radiographic images were reviewed.
  
  
  RESULTS
  Twelve of thirteen fractures were united both clinically and radiologically within a year after adjuvant TPTD. Union completed radiologically median 5.4 months and clinically 5.7 months after the medication, respectively. Callus appeared abundantly showing median 1.4 of fracture healing response postoperatively. There was no serious adverse reaction of medication other than itching, muscle cramp, or nausea.
  
  
  CONCLUSIONS
  Even appropriate surgical treatment is a mainstay of treatment for AFF, PPFF, and FNU, the current report suggested that adjuvant TPTD combined with stable fixation results in satisfactory outcome for the challenging fractures of femur.
authors: Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, Korea.
authors: Jung Taek
authors: JT
authors: Kim
authors: Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, Korea.
authors: Hyung Jun
authors: HJ
authors: Jeong
authors: Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, Korea.
authors: Soong Joon
authors: SJ
authors: Lee
authors: Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, Korea.; Seoul National University Medical Research Center, Seoul, Korea.
authors: Hee Joong
authors: HJ
authors: Kim
authors: Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, Korea.
authors: Jeong Joon
authors: JJ
authors: Yoo
keywords: Atypical femoral fracture; Femoral nonunion; Femur; Periprosthetic fractures; Terip