PTH 1-34 (teriparatide) may not improve healing in proximal humerus fractures: A randomized,controlled study of 40 patients

Results39 patients completed the follow-up. The radiographic assessment showed a correct correlation, “better” in the teriparatide group and “normal” in the control group, in 21 of the 39 cases. There were no statistically significant differences in pain, in use of strong analgesics, or in function between the groups at the follow-up examinations.InterpretationThere were no radiographic signs of enhanced healing or improved clinical results in the group treated with teriparatideDuring the last 15 years, researchers have tried to improve fracture healing by using additional medication or growth factors such as bisphosphonates, bone morphogenetic proteins (BMPs), and parathyroid hormone (PTH). The hopes for improvement involved 2 different considerations, faster fracture healing and a reduced proportion of non-unions (Aspenberg 2013).Bisphosphonates, systemic or locally administered, have been shown to improve implant fixation, but their role in fracture treatment is unclear (Abtahi et al. 2012, Hilding and Aspenberg 2006, 2007). BMPs are thought to initiate fracture healing, but they have obvious side effects such as local swelling, pain, and increased risk of wound infections (Aro et al. 2011, Carragee et al. 2011). Studies sponsored by industry have obviously not reported the adverse effects associated with the administration of BMPs in spinal fusion (Carragee et al. 2011). There is also reason to believe that there is an increased risk of cancer after BMP treatment (Carragee et al. 2013).Animal studies have shown that there is accelerated fracture healing after intermittent injections with parathyroid hormone (PTH) (Skripitz and Aspenberg 2004, Chalidis et al. 2007). So far, only 3 papers have been published concerning PTH and fracture repair in humans. 2 papers with data from the same randomized trial involving distal radius fractures showed accelerated healing and improved callus formation (Aspenberg et al. 2010, Aspenberg and Johansson 2010). The radiological analysis showed minimal improvement in the position of the healed fracture, and there was no improvement in function. The third paper compared PTH 1-84 with placebo, and showed better healing in pubic bone fractures at 2 months in the treatment group, together with less pain and better walking ability (Peichl et al. 2011). However, that study had some methodological shortcomings. In conclusion, these studies have suggested that PTH may improve fracture healing in humans but the clinical importance for different diagnoses must be investigated and confirmed.The main aim of this study was to determine whether teriparatide enhances fracture healing of proximal humerus fractures, as evaluated on radiographs at 7 weeks. Secondary aims were to compare function, pain, and the use of opioid analgesics before the fracture, at 7 weeks, and after 3 months.