Efficacy and Safety of Teriparatide in Improving Fracture Healing and Callus Formation: A Systematic Review

Chaitanya S Puvvada; Faiza H Soomro; Hafsa A Osman; Merna Haridi; Natalie A Gonzalez; Sana M Dayo; Umaima Fatima; Aaiyat Sheikh; Sai Sri Penumetcha

doi:10.7759/cureus.37478

Efficacy and Safety of Teriparatide in Improving Fracture Healing and Callus Formation: A Systematic Review

Cureus. 2023 Apr 12;15(4):e37478. doi: 10.7759/cureus.37478. eCollection 2023 Apr.

Authors

Chaitanya S Puvvada^{1

2}, Faiza H Soomro^{3

4}, Hafsa A Osman⁵, Merna Haridi⁶, Natalie A Gonzalez⁵, Sana M Dayo⁷, Umaima Fatima¹, Aaiyat Sheikh⁸, Sai Sri Penumetcha^{9

10}

Affiliations

¹ Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA.
² Internal Medicine, Gayatri Vidya Parishad Institute of Health Care and Medical Technology, Visakhapatnam, IND.
³ General Surgery, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA.
⁴ General Surgery, NineWells Hospital, NHS Tayside, Dundee, GBR.
⁵ Pediatrics, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA.
⁶ Medical Education, Saint Martinus University, Curacao, CUW.
⁷ Obstetrics and Gynecology, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA.
⁸ Internal Medicine, Era's Lucknow Medical College & Hospital, Lucknow, IND.
⁹ General Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA.
¹⁰ General Medicine, Chalmeda Anand Rao Institute of Medical Sciences, Karimnagar, IND.

Abstract

Fracture nonunion remains a great challenge for orthopedic surgeons. Some bone fractures don't heal promptly, resulting in delayed unions and nonunions, and there is a need for an additional surgical procedure. Previous research has shown that teriparatide, a type of synthetic parathyroid hormone, can promote the formation of callus and lead to healing in individuals with delayed or non-healing bone fractures. Limited systematic reviews exist that examine the use of teriparatide in cases of delayed healing or non-healing bone fractures, which have their limitations. In this review, we overcome those limitations by including prospective studies, retrospective studies, case reports, and case series together. A systematic search of the literature was conducted in both PubMed and Google Scholar up to September of the year 2022. The studies included in our research included adult patients (over the age of 16) diagnosed with delayed union or nonunion of any bone in the body (flat bone, long bone, short bone, or irregular bone). The studies were limited to those written in English. The outcomes that were tracked and recorded include the healing of the fracture and any negative side effects or adverse events. The initial search yielded 504 abstracts and titles. After reviewing these, 32 articles were selected for further analysis, which included 19 case reports, five case series, two retrospective studies, and six prospective studies. Studies included daily (20 micrograms) or weekly (56.5 micrograms) subcutaneous administration of teriparatide. The duration of follow-up for these studies varied from three to 24 months. Based on the available research, it appears that administering teriparatide subcutaneously is a safe treatment option for delayed healing and non-healing bone fractures, with very few to no reported negative side effects. Using teriparatide for induction of callus formation and treating delayed and nonunions is highly safe and effective.

Keywords: callus; delayed union; fracture; nonunion; parathyroid hormone; teriparatide.

Publication types

Review