Teriparatide therapy prevents delayed unions or non unions in patients with fractures

Teriparatide has the potential to be useful in the treatment of some types of delayed unions or non-unions, even in the context of hardware failure, says an article published in BMC Musculoskeletal Disorders.

The orthopaedic surgeon has a significant difficulty when it comes to delayed bone healing and nonunions. In addition to traditional surgical approaches, more emphasis is being placed on the use of systemic anabolic treatment with Teriparatide, whose efficacy in preventing osteoporotic fractures has been widely validated and whose application as a promoter of bone healing has been described but remains controversial.

As a result, Gabriele Gariffo and colleagues undertook this research to assess bone healing in a group of patients with delayed unions or nonunions who were treated with Teriparatide in combination with an eventual suitable surgical operation.

20 patients with an unconsolidated fracture who were treated with Teriparatide at our institutions between 2011 and 2020 were included in the research retrospectively. The pharmaceutical anabolic support was administered off-label for 6 months, and radiographic healing was assessed at 1-, 3-, and 6-month follow-up outpatient visits using plain radiographs. Additionally, potential negative effects were recorded.

The key findings of this study were:

1. Radiographic evidence of favorable evolution of the bone callus were found in 15% of patients as early as 1 month of therapy; at 3 months, healing advancement was noted in 80% of cases and full healing in 10%; and at 6 months, 85% of delayed and nonunion had healed.

2. The anabolic treatment was well tolerated by all patients.

Despite the small number of patients included, this study found that Teriparatide significantly improved the pathological state of individuals suffering from nonunion over the months of treatment, demonstrating how this medication can play a leading role in the treatment of this disease. Although the findings are encouraging, more research, particularly prospective and randomized trials, are required to establish the drug's effectiveness and identify a precise treatment strategy.

Reference:

Gariffo, G., Bottai, V., Falcinelli, F., Di Sacco, F., Cifali, R., Troiano, E., Capanna, R., Mondanelli, N., & Giannotti, S. (2023). Use of Teriparatide in preventing delayed bone healing and nonunion: a multicentric study on a series of 20 patients. In BMC Musculoskeletal Disorders (Vol. 24, Issue 1). Springer Science and Business Media LLC. https://doi.org/10.1186/s12891-023-06278-0