Recent Clinical Advancement of the Effects of Parathyroid Analogues on Fracture Healing in Humans: A Review of Literature

Problem statement: Numerous animal studies have shown that administration of Parathyroid Hormone (PTH) or a related analogue promotes callus formation and bone union. However, there has yet to be sufficient evidence in human subjects to justify the use of PTH or related analogues in promoting fracture healing. The purpose of this paper is to (1) review all literature involving the use of PTH analogues in humans (2) compare the clinical efficacy of PTH analogues to conventional management of fracture healing and (3) evaluate the safety profile and potential side-effects of PTH analogues administered in humans. Approach: We conducted a systematic review of multiple databases analysing papers within the last 10 years. All studies involving the use of PTH analogues in humans were included. All animal studies were excluded. Appropriate statistics regarding patient’s age, gender, site of fracture, teriparatide treatment regime, clinical outcomes and imaging outcomes were extracted, analysed and summarized. Results: A total of 10 observational studies and 2 randomized controlled trials were evaluated in this study. With administration of teriparatide (PTH1-34), the mean time to 100% disappearance of fracture site pain was 3.1 months ±0.7 months. Delayed or non-union fractures achieved bony bridging in 4.3 months. For new fractures treated non-surgically, there have been reports of shorter time to cortical bridging in the treatment group (7.4 weeks, n = 34, p = 0.006) as compared to the control group (9.1 weeks, n = 34). Lastly, a total of 8 out of 254 patients (3.1%) experienced mild side effect from teriparatide administration. Conclusion: Teriparatide shows promise to be a viable option for the treatment of fractures. Although initial studies do prove encouraging, greater evidence is needed to evaluate the optimal dosing regimen and the patient and fracture types that would achieve the best response.