Efficacy of Teriparatide in Improving Fractures Union and Healing: A Systematic Review and Meta-Analysis

Abstract

Abstract Background Fractures often contribute to high mortality and adverse outcomes in the geriatric population. During recovery from fracture, most patients experience fracture reduced mobility and impaired ability to perform routine daily activities, with a large proportion failing to regain their refracture functional level after 1 year. Aim of the Work This systematic review and meta-analysis study aimed to determine the role of teriparatide (recombinant human parathyroid hormone) for bone fracture healing in adults by comparing the different effects between PTH analogues and any other treatments (e.g. anti-osteoporosis drugs, placebo, standard care….etc.), regarding functional recovery, fracture union, and adverse events. Methods Searching process was performed using advanced search strategy on scientific databases. Inclusion criteria were adult patients administrated teriparatide after surgical fixation of fractures. We included all types of study design except case report and case series. The searching and identification process resulted in 16 papers which included in this study. Results Time to union were lower in TPTD group than non-TPTD group. The rates of fracture union after 3 and 6 months were similar in both groups. There were a significant improvement in bone mineral density when using teriparatide more than 6 months after surgical intervention for treatment of fracture. Varus collapse were lower in TPTD group than non-TPTD group. There were a significant improvement in functional outcome when using teriparatide post-operatively. HHS were higher in teriparatide (TPTD) group than non-TPTD group. Incidence of mal- union/nonunion and subsequent fracture were lower in TPTD group than non-TPTD group. Mortality rate were lower in TPTD group than non-TPTD group. Reoperation rate, complications’ rate and deformity rate were similar in TPTD group and non-TPTD group. Conclusion The using of teriparatide after fractures’ surgical fixation improve functional and radiological outcome and reduce time to union, rate of femoral shortening, degree of varus collapse and mortality rate especially in osteoporotic patients.