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Saito K, Toyoda H, Okada M, Oh JS, Nakazawa K, Ban Y, Orita K, Shimatani A, Yao H, Shirafuji T, Nakamura H. Fracture healing on non-union fracture model promoted by non-thermal atmospheric-pressure plasma. PLoS One 2024; 19:e0298086. [PMID: 38626076 PMCID: PMC11020618 DOI: 10.1371/journal.pone.0298086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 01/17/2024] [Indexed: 04/18/2024] Open
Abstract
Non-thermal atmospheric-pressure plasma (NTAPP) is attracting widespread interest for use in medical applications. The tissue repair capacity of NTAPP has been reported in various fields; however, little is known about its effect on fracture healing. Non-union or delayed union after a fracture is a clinical challenge. In this study, we aimed to investigate how NTAPP irradiation promotes fracture healing in a non-union fracture model and its underlying mechanism, in vitro and in vivo. For the in vivo study, we created normal and non-union fracture models in LEW/SsNSlc rats to investigate the effects of NTAPP. To create a fracture, a transverse osteotomy was performed in the middle of the femoral shaft. To induce the non-union fracture model, the periosteum surrounding the fracture site was cauterized after a normal fracture model was created. The normal fracture model showed no significant difference in bone healing between the control and NTAPP-treated groups. The non-union fracture model demonstrated that the NTAPP-treated group showed consistent improvement in fracture healing. Histological and biomechanical assessments confirmed the fracture healing. The in vitro study using pre-osteoblastic MC3T3-E1 cells demonstrated that NTAPP irradiation under specific conditions did not reduce cell proliferation but did enhance osteoblastic differentiation. Overall, these results suggest that NTAPP is a novel approach to the treatment of bone fractures.
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Affiliation(s)
- Kosuke Saito
- Department of Orthopedic Surgery, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Hiromitsu Toyoda
- Department of Orthopedic Surgery, Graduate School of Medicine, Osaka City University, Osaka, Japan
- Department of Orthopedic Surgery, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Mitsuhiro Okada
- Department of Orthopedic Surgery, Graduate School of Medicine, Osaka City University, Osaka, Japan
- Department of Orthopedic Surgery, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Jun-Seok Oh
- Department of Physics and Electronics, Graduate School of Engineering, Osaka Metropolitan University, Osaka, Japan
| | - Katsumasa Nakazawa
- Department of Orthopedic Surgery, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Yoshitaka Ban
- Department of Orthopedic Surgery, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Kumi Orita
- Department of Orthopedic Surgery, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Akiyoshi Shimatani
- Department of Orthopedic Surgery, Saiseikai Nakatsu Hospital, Osaka, Japan
| | - Hana Yao
- Department of Orthopedic Surgery, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
| | - Tatsuru Shirafuji
- Department of Physics and Electronics, Graduate School of Engineering, Osaka Metropolitan University, Osaka, Japan
| | - Hiroaki Nakamura
- Department of Orthopedic Surgery, Graduate School of Medicine, Osaka City University, Osaka, Japan
- Department of Orthopedic Surgery, Graduate School of Medicine, Osaka Metropolitan University, Osaka, Japan
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Nho JH, Jang BW, Lee DW, Kim JH, Lim TK, Cha SM, Seo DK, Park YG, Kang DG, Lee YK, Ha YC. Position Statement: Atypical Femoral Fracture from the Korean Society for Bone and Mineral Research in 2023. J Bone Metab 2023; 30:209-217. [PMID: 37718899 PMCID: PMC10509028 DOI: 10.11005/jbm.2023.30.3.209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 07/06/2023] [Accepted: 07/21/2023] [Indexed: 09/19/2023] Open
Abstract
As the aging population increases, the number of patients with osteoporosis is gradually rising. Osteoporosis is a metabolic bone disease characterized by low bone mass and the microarchitectural deterioration of bone tissue, resulting in reduced bone strength and an increased risk of low-energy or fragility fractures. Thus, the use of anti-resorptive agents, such as bisphosphonates (BPs), to prevent osteoporotic fractures is growing annually. BPs are effective in reducing hip and other fractures. However, the longer a patient takes BPs, the higher the risk of an atypical femoral fracture (AFF). The exact mechanism by which long-term BP use affects the development of AFFs has not yet been clarified. However, several theories have been suggested to explain the pathogenesis of AFFs, such as suppressed bone remodeling, impaired bone healing, altered bone quality, and femoral morphology. The management of AFFs requires both medical and surgical approaches. BPs therapy should be discontinued immediately, and calcium and vitamin D levels should be evaluated and supplemented if insufficient. Teriparatide can be used for AFFs. Intramedullary nailing is the primary treatment for complete AFFs, and prophylactic femoral nailing is recommended if signs of an impending fracture are detected.
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Affiliation(s)
- Jae-Hwi Nho
- Department of Orthopaedic Surgery, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul,
Korea
| | - Byung-Woong Jang
- Department of Orthopaedic Surgery, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul,
Korea
| | - Dong Woo Lee
- Department of Orthopaedic Surgery, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul,
Korea
| | - Jae-Hyun Kim
- Department of Orthopaedic Surgery, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon,
Korea
| | - Tae Kang Lim
- Department of Orthopaedic Surgery, Nowon Eulji Medical Center, Eulji University School of Medicine, Seoul,
Korea
| | - Soo Min Cha
- Department of Orthopaedic Surgery, Regional Rheumatoid and Degenerative Arthritis Center, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon,
Korea
| | - Dong-Kyo Seo
- Department of Orthopaedic Surgery, Gangneung Asan Hospital, Ulsan University College of Medicine, Gangneung,
Korea
| | - Yong-Geun Park
- Department of Orthopaedic Surgery, Jeju National University Hospital, Jeju National University School of Medicine, Jeju,
Korea
| | - Dong-Geun Kang
- Department of Orthopaedic Surgery, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Jinju,
Korea
| | - Young-Kyun Lee
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam,
Korea
| | - Yong-Chan Ha
- Department of Orthopaedic Surgery, Seoul Bumin Hospital, Seoul,
Korea
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Gao J, Liu X, Wu X, Li X, Liu J, Li M. A brief review and clinical evidences of teriparatide therapy for atypical femoral fractures associated with long-term bisphosphonate treatment. Front Surg 2023; 9:1063170. [PMID: 36684309 PMCID: PMC9852062 DOI: 10.3389/fsurg.2022.1063170] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 11/07/2022] [Indexed: 01/07/2023] Open
Abstract
The risk of bisphosphonate (BP)-associated atypical femur fracture (AFF) has markedly increased over recent decades due to suppression of bone turnover, accumulation of structural micro-damage and reduction of bone remodeling consequent to long-term BP treatment. These medications further delay bone union and result in challenging clinical management. Teriparatide (TPTD), a synthetic human parathyroid hormone, exhibits unique anabolic effects and can increase bone remodeling and improve bone microarchitecture, further promoting fracture healing and reducing the rate of bone non-union. In this study, we briefly define AFF as well as the effects of BPs on AFFs, detailed the role of TPTD in AFF management and the latest clinical therapeutic findings. We have confirmed that TPTD positively promotes the healing of AFFs by reducing the time to bone union and likelihood of non-union. Thus, teriparatide therapy could be considered as an alternative treatment for AFFs, however, further research is required for the establishment of effective clinical guidelines of TPTD use in the management of AFF.
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Affiliation(s)
- Jianpeng Gao
- Department of Orthopaedics, Chinese PLA General Hospital, Beijing, China,National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, China
| | - Xiao Liu
- Department of Orthopaedics, Chinese PLA General Hospital, Beijing, China,National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, China
| | - Xiaoyong Wu
- Department of Orthopaedics, Chinese PLA General Hospital, Beijing, China
| | - Xiaoya Li
- Department of Orthopaedics, Chinese PLA General Hospital, Beijing, China
| | - Jianheng Liu
- Department of Orthopaedics, Chinese PLA General Hospital, Beijing, China,National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, China,Correspondence: Ming Li Jianheng Liu
| | - Ming Li
- Department of Orthopaedics, Chinese PLA General Hospital, Beijing, China,National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, China,Correspondence: Ming Li Jianheng Liu
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Png MA, Koh JSB, Mohan PC, Howe CY, Howe TS. Factors affecting healing and progression of conservatively treated incomplete atypical femoral fractures: retrospective observational study. J Bone Miner Metab 2023; 41:61-73. [PMID: 36371726 DOI: 10.1007/s00774-022-01378-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 10/09/2022] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Incomplete atypical femoral fractures (iAFF) may occur with prolonged bisphosphonate usage. Factors influencing iAFF healing and progression are not well understood. This study of conservatively managed iAFF assessed factors influencing iAFF healing and progression including the effects of bisphosphonates and teriparatide use. MATERIALS AND METHODS Single-center retrospective observational study of 69 consecutive patients with 78 radiographically confirmed iAFF from 2002 to 2017. Serial radiographs assessed for focal cortical thickening, dreaded black line (DBL) and complete fracture. Chief outcome measures were DBL healing and complete fracture. RESULTS DBL had a significant association (p < 0.05) with fracture progression by multivariable logistic regression (55.8% versus 25.7%, odds ratio [OR] 26.57 (95% CI 1.40-504.78)) and shorter fracture-free survival (mean 3.21 versus 6.27 years). Presence of symptoms was associated with shorter fracture-free survival (mean 2.68 versus 5.98 years). Discontinuing bisphosphonates had significant associations (p < 0.001) by multivariable logistic regression with decreased fracture rate (11.6% versus 92.0%; OR 0.00, 95% CI 0.00-0.08) and longer fracture-free survival (mean 7.52 versus 1.99 years). DBL healing occurred in 36.4%, only when bisphosphonates were discontinued. Age, sex, race, fracture site, glucocorticoid use, teriparatide supplementation and duration of bisphosphonate use showed no statistically significant effect although teriparatide use appeared to improve DBL healing (50% versus 17.9%, p = 0.188). CONCLUSIONS In conservatively managed iAFF, DBL healing occurred in 36.4% if bisphosphonates were discontinued. Bisphosphonates and DBL were significantly associated with fracture progression and together with symptoms with fracture survival.
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Affiliation(s)
- Meng Ai Png
- Department of Diagnostic Radiology, Singapore General Hospital, Outram Road, Singapore, 169608, Republic of Singapore.
| | - Joyce Suang Bee Koh
- Department of Orthopedic Surgery, Singapore General Hospital, Outram Road, Singapore, 169608, Republic of Singapore
| | - P Chandra Mohan
- Department of Diagnostic Radiology, Singapore General Hospital, Outram Road, Singapore, 169608, Republic of Singapore
| | - Choong Yin Howe
- , 36 Jalan Sejarah, Singapore, 299077, Republic of Singapore
| | - Tet Sen Howe
- Department of Orthopedic Surgery, Singapore General Hospital, Outram Road, Singapore, 169608, Republic of Singapore
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Lee S, Seo YJ, Choi JY, Che X, Kim HJ, Eum SY, Hong MS, Lee SK, Cho DC. Effect of teriparatide on drug treatment of tuberculous spondylitis: an experimental study. Sci Rep 2022; 12:21667. [PMID: 36522387 PMCID: PMC9755294 DOI: 10.1038/s41598-022-25174-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 11/25/2022] [Indexed: 12/23/2022] Open
Abstract
Tuberculous spondylitis often develops catastrophic bone destruction with uncontrolled inflammation. Because anti-tuberculous drugs do not have a role in bone formation, a combination drug therapy with a bone anabolic agent could help in fracture prevention and promote bone reconstruction. This study aimed to investigate the influence of teriparatide on the effect of anti-tuberculous drugs in tuberculous spondylitis treatment. We used the virulent Mycobacterium tuberculosis (Mtb) H37Rv strain. First, we investigated the interaction between teriparatide and anti-tuberculosis drugs (isoniazid and rifampin) by measuring the minimal inhibitory concentration (MIC) against H37Rv. Second, we evaluated the therapeutic effect of anti-tuberculosis drugs and teriparatide on our previously developed in vitro tuberculous spondylitis model of an Mtb-infected MG-63 osteoblastic cell line using acid-fast bacilli staining and colony-forming unit counts. Selected chemokines (interleukin [IL]-8, interferon γ-induced protein 10 kDa [IP-10], monocyte chemoattractant protein [MCP]-1, and regulated upon activation, normal T cell expressed and presumably secreted [RANTES]) and osteoblast proliferation (alkaline phosphatase [ALP] and alizarin red S [ARS] staining) were measured. Teriparatide did not affect the MIC of isoniazid and rifampin. In the Mtb-infected MG-63 spondylitis model, isoniazid and rifampin treatment significantly reduced Mtb growth, and cotreatment with teriparatide did not change the anti-tuberculosis effect of isoniazid (INH) and rifampin (RFP). IP-10 and RANTES levels were significantly increased by Mtb infection, whereas teriparatide did not affect all chemokine levels as inflammatory markers. ALP and ARS staining indicated that teriparatide promoted osteoblastic function even with Mtb infection. Cotreatment with teriparatide and the anti-tuberculosis drugs activated bone formation (ALP-positive area increased by 705%, P = 0.0031). Teriparatide was effective against Mtb-infected MG63 cells without the anti-tuberculosis drugs (ARS-positive area increased by 326%, P = 0.0037). Teriparatide had no effect on the efficacy of anti-tuberculosis drugs and no adverse effect on the activity of Mtb infection in osteoblasts. Furthermore, regulation of representative osteoblastic inflammatory chemokines was not changed by teriparatide treatment. In the in vitro Mtb-infected MG-63 cell model of tuberculous spondylitis, cotreatment with the anti-tuberculosis drugs and teriparatide increased osteoblastic function.
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Affiliation(s)
- Subum Lee
- Department of Neurosurgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Ye-Jin Seo
- Department of Neurosurgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, 130 Dongduk-Ro, Jung-Gu, Daegu, Republic of Korea
| | - Je-Yong Choi
- Department of Biochemistry and Cell Biology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Xiangguo Che
- Department of Biochemistry and Cell Biology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Hyun-Ju Kim
- Department of Biochemistry and Cell Biology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Seok-Yong Eum
- Division of Immunopathology and Cellular Immunology, International Tuberculosis Research Center, Gyeongsangnam-Do, Changwon-Si, Republic of Korea
| | - Min-Sun Hong
- Division of Immunopathology and Cellular Immunology, International Tuberculosis Research Center, Gyeongsangnam-Do, Changwon-Si, Republic of Korea
| | - Sun-Kyoung Lee
- Division of Immunopathology and Cellular Immunology, International Tuberculosis Research Center, Gyeongsangnam-Do, Changwon-Si, Republic of Korea
| | - Dae-Chul Cho
- Department of Neurosurgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, 130 Dongduk-Ro, Jung-Gu, Daegu, Republic of Korea.
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Kempenaers K, Claes T, Van Beek N, Claes S. IC-Type Electric stimulation for delayed bone healing: monocentric evaluation over eight years of experience. Acta Orthop Belg 2022; 88:525-532. [PMID: 36791706 DOI: 10.52628/88.3.6890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
Electrostimulation is suggested to positively influence bone healing for delayed unions of both fractures and osteotomies. This monocentric series aims to retrospectively assess the outcome of electrostimulation treatment for delayed union after traumatic fractures or knee osteotomy. Patients treated with electrostimulation for delayed union (no bony union on radiographic imaging at 90 days after osteotomy or fracture treatment) over an 8-year period were screened. The delay of treatment, success rate, revision rate and demographic data (age, sex, location of fracture, presence of osteosynthesis materials) were investigated. A questionnaire assessed objective (nicotine abuse, NRS pain assessment, activity levels) and subjective (comfort, usability, cost-effectiveness) aspects. Electrostimulation delivered radiographic healing in 75% of the fracture group and 66% of the osteotomy group. No statistical significant difference (N=136) in success rate was found for age, sex, presence of osteosynthesis material, delay or fracture location. Success rate did differ significantly with pain, activity level and smoking (p<0.05). Reflective questions to patients were answered mostly positively. The use of electrostimulation for the delayed union of fractures and knee osteotomies delivers high healing rates avoiding the burden of surgical reintervention. It is generally well received by the patient. No difference in success rate was found between sex, age or fracture location, nor did the delay of therapy onset or presence of osteosynthesis material seem to affect the success rate. Smoking had a negative influence on the efficacy of bone electrostimulation.
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Lee SY, Kawasaki K, Inagaki K. Successful treatment of humeral shaft nonunion with romosozumab: A case report. Trauma Case Rep 2022; 37:100595. [PMID: 35005169 PMCID: PMC8718983 DOI: 10.1016/j.tcr.2021.100595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2021] [Indexed: 11/15/2022] Open
Abstract
Romosozumab is a humanized monoclonal anti-sclerostin antibody (Scl-Ab) that binds and inhibits sclerostin, thereby increasing bone formation and decreasing bone resorption. In 2019, the Japanese Ministry of Health, Labor and Welfare, and the FDA approved romosozumab for treating osteoporosis in men and in postmenopausal women at high risk of fracture. In the past decade, pharmacological systemic treatments using molecules in use for the treatment of the osteoporosis have been reported. Herein we reported the case of a 67-year-old woman with nonunion of humerus shaft fracture, in whom bone union could not be achieved after 11 months of conservative treatment; however, successful bone healing was achieved after once-a-month administration of romosozumab for 6 months. To our knowledge, this is the first case reporting the successful use of romosozumab for treating established nonunion. Romosozumab can aid in promoting bone healing of nonunion in patients not willing to undergo surgical intervention.
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Affiliation(s)
- Sang Yang Lee
- Department of Orthopaedic Surgery, Showa University School of Medicine, 1-5-8 Hatano-dai, Shinagawa-ku, Tokyo, Japan
- Department of Orthopaedic Surgery, Keijinkai Shiroyama Hospital, 1 Iizuka-cho, Ota, Japan
| | - Keikichi Kawasaki
- Department of Orthopaedic Surgery, Keijinkai Shiroyama Hospital, 1 Iizuka-cho, Ota, Japan
- Department of Orthopaedic Surgery, Showa University Northern Yokohama Hospital, 35-1, Chigasaki-chuo, Tsuzuki-ku, Yokohama, Japan
| | - Katsunori Inagaki
- Department of Orthopaedic Surgery, Showa University School of Medicine, 1-5-8 Hatano-dai, Shinagawa-ku, Tokyo, Japan
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Nieves JW, Cosman F, McMahon D, Redko M, Hentschel I, Bartolotta R, Loftus M, Kazam JJ, Rotman J, Lane J. Teriparatide and pelvic fracture healing: a phase 2 randomized controlled trial. Osteoporos Int 2022; 33:239-250. [PMID: 34383100 PMCID: PMC8758515 DOI: 10.1007/s00198-021-06065-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 07/08/2021] [Indexed: 01/03/2023]
Abstract
UNLABELLED Pelvic fracture patients were randomized to blinded daily subcutaneous teriparatide (TPTD) or placebo to assess healing and functional outcomes over 3 months. With TPTD, there was no evidence of improved healing by CT or pain reduction; however, physical performance improved with TPTD but not placebo (group difference p < 0.03). INTRODUCTION To determine if teriparatide (20 μg/day; TPTD) results in improved radiologic healing, reduced pain, and improved functional outcome vs placebo over 3 months in pelvic fracture patients. METHODS This randomized, placebo-controlled study enrolled 35 patients (women and men >50 years old) within 4 weeks of pelvic fracture and evaluated the effect of blinded TPTD vs placebo over 3 months on fracture healing. Fracture healing from CT images at 0 and 3 months was assessed as cortical bridging using a 5-point scale. The numeric rating scale (NRS) for pain was administered monthly. Physical performance was assessed monthly by Continuous Summary Physical Performance Score (based on 4 m walk speed, timed repeated chair stands, and balance) and the Timed Up and Go (TUG) test. RESULTS The mean age was 82, and >80% were female. The intention to treat analysis showed no group difference in cortical bridging score, and 50% of fractures in TPTD-treated and 53% of fractures in placebo-treated patients were healed at 3 months, unchanged after adjustment for age, sacral fracture, and fracture displacement. Median pain score dropped significantly in both groups with no group differences. Both CSPPS and TUG improved in the teriparatide group, whereas there was no improvement in the placebo group (group difference p < 0.03 for CSPPS at 2 and 3 months). CONCLUSION In this small randomized, blinded study, there was no improvement in radiographic healing (CT at 3 months) or pain with TPTD vs placebo; however, there was improved physical performance in TPTD-treated subjects that was not evident in the placebo group.
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Affiliation(s)
- J W Nieves
- Hospital for Special Surgery, New York, NY, USA.
- Department of Epidemiology, Columbia University, New York, NY, USA.
| | - F Cosman
- Department of Medicine, Columbia University, New York, NY, USA
| | - D McMahon
- Hospital for Special Surgery, New York, NY, USA
| | - M Redko
- Hospital for Special Surgery, New York, NY, USA
| | - I Hentschel
- Hospital for Special Surgery, New York, NY, USA
| | - R Bartolotta
- Department of Radiology, University of Colorado School of Medicine, Aurora, CO, USA
| | - M Loftus
- Department of Radiology, Weill Cornell Medicine, New York, NY, USA
| | - J J Kazam
- Department of Radiology, Weill Cornell Medicine, New York, NY, USA
| | - J Rotman
- Department of Radiology, Weill Cornell Medicine, New York, NY, USA
| | - J Lane
- Hospital for Special Surgery, New York, NY, USA
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Tsuchie H, Miyakoshi N, Kasukawa Y, Nozaka K, Saito K, Kinoshita H, Kobatyashi M, Suzuki N, Aizawa T, Abe H, Maekawa S, Tomite T, Ono Y, Ouchi K, Shibata N, Nagahata I, Takeshima M, Akagawa M, Yuasa Y, Sato C, Shimada Y. Evaluation of factors affecting the occurrence of second atypical fracture after bone union of the first atypical fracture. Bone 2021; 143:115671. [PMID: 33007529 DOI: 10.1016/j.bone.2020.115671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 09/21/2020] [Accepted: 09/26/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Teriparatide is sometimes used in the treatment of atypical femoral fracture (AFF). Even if bone union is achieved, orthopedic physicians must consider the risk of relapse. This study aimed to investigate the factors affecting AFF recurrence, and to determine the appropriate treatment for osteoporosis after bone union. METHODS One hundred thirty-one consecutive AFFs in 113 Japanese patients were included. Eleven patients had AFF in the unaffected limb (9 patients) after the first AFF or re-fracture at the original fracture site (2 patients) after bone union of the first AFF was confirmed. We divided all patients into two groups: the second fracture group (22 AFFs in 11 patients) and non-second fracture group (109 AFFs in 102 patients). We compared clinical information between the 2 groups and investigated the factors affecting AFF recurrence using the Student t-, Welch t-, and chi-square tests. RESULTS Although there was no significant difference in clinical characteristics between the 2 groups, multivariate analysis of factors associated with AFF recurrence identified short duration of treatment with teriparatide and active vitamin D3 (p = 0.0408 and 0.0366, respectively) as risk factors. Even in the analysis excluding subtrochanteric AFF, short periods of teriparatide and active vitamin D3 administration were observed as risk factors (p = 0.0484 and 0.0346, respectively). CONCLUSION The administration of teriparatide for as long as possible after occurrence first AFF and the use of active vitamin D3 after completion of teriparatide therapy may be the most effective strategy to prevent the recurrence of AFF.
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Affiliation(s)
- Hiroyuki Tsuchie
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita 010-8543, Japan.
| | - Naohisa Miyakoshi
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita 010-8543, Japan
| | - Yuji Kasukawa
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita 010-8543, Japan
| | - Koji Nozaka
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita 010-8543, Japan
| | - Kimio Saito
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita 010-8543, Japan; Department of Orthopedic Surgery, Kakunodate General Hospital, 3 Iwase, Kakunodate, Senboku 014-0394, Japan
| | - Hayato Kinoshita
- Department of Orthopedic Surgery, Akita Kousei Medical Center, 1-1-1 Iijima, Nishifukuro, Akita 011-0948, Japan
| | - Moto Kobatyashi
- Department of Orthopedic Surgery, Hiraka General Hospital, 3-1, Yatsuguchi, Maego, Yokote 013-8610, Japan
| | - Norio Suzuki
- Department of Orthopedic Surgery, Yuri Kumiai General Hospital, Kawaguchi aza Yaushiro, Yurihonjyo 015-8511, Japan
| | - Toshiaki Aizawa
- Department of Orthopedic Surgery, Northern Akita Municipal Hospital, 16-29 Shimosugi aza Kamishimizusawa, Kitaakita 018-4221, Japan
| | - Hidekazu Abe
- Department of Orthopedic Surgery, Ugo Municipal Hospital, 44-5 Otomichi, Nishomonai, Ugo 012-1131, Japan
| | - Shigeto Maekawa
- Department of Orthopedic Surgery, Ogachi Central Hospital, 25 Yamada aza Isamigaoka, Yuzawa 012-0055, Japan
| | - Takanori Tomite
- Department of Orthopedic Surgery, Japanese Red Cross Akita Hospital, 222-1 Saruta aza Inawashirosawa, Kamikitate, Akita 010-1495, Japan
| | - Yuichi Ono
- Department of Orthopedic Surgery, Nakadori General Hospital, 3-15 Misono-cho, Minami-dori, Akita 010-8577, Japan
| | - Kentaro Ouchi
- Department of Orthopedic Surgery, Yokote Municipal Hospital, 5-31 Negishimachi, Yokote 013-8602, Japan
| | - Nobusuke Shibata
- Department of Orthopedic Surgery, Oga Minato Municipal Hospital, 1-8-6 Funakawa aza Kaigandori, Oga 010-0051, Japan
| | - Itsuki Nagahata
- Department of Orthopedic Surgery, Omagari Kousei Medical Center, 8-65 Omagari Torimachi, Daisen 014-0027, Japan
| | - Masaaki Takeshima
- Department of Orthopedic Surgery, Honjyo Daiichi Hospital, 111 Iwabuchishita, Yurihonjyo 015-8567, Japan
| | - Manabu Akagawa
- Department of Orthopedic Surgery, Akita City Hospital, 4-30 Matsuokamachi, Kawamoto, Akita 010-0933, Japan
| | - Yusuke Yuasa
- Department of Orthopedic Surgery, Omori Municipal Hospital, 245-205 Omori aza Sugouta, Yokote 013-0525, Japan
| | - Chie Sato
- Department of Orthopedic Surgery, Akita Rosai Hospital, 30 Karuizawa aza Shimotai, Odate 018-5604, Japan
| | - Yoichi Shimada
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita 010-8543, Japan
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Spalteholz M, Gulow J. Percutaneous triangular stabilization of type 3 and type 4 fragility fractures of the pelvis usually leads to fracture healing despite high revision rates. GMS INTERDISCIPLINARY PLASTIC AND RECONSTRUCTIVE SURGERY DGPW 2020; 9:Doc05. [PMID: 33391966 PMCID: PMC7745701 DOI: 10.3205/iprs000149] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This is a monocentric, retrospective study to analyze radiological findings as well as perioperative and postoperative complications in patients who underwent percutaneous triangular stabilization of type 3 and type 4 fragility fractures of the pelvis. From August 2017 to December 2018, 20 patients were treated surgically. Thirteen patients (65%) were followed-up and received a CT scan of the pelvis after an average time of 14.8 months. A total of 5 patients (38%) had to undergo revision surgery, 2 patients (15%) immediately, 3 patients (23%) in the interval. In 84.6% no fracture line was visible in the sacrum. Fracture healing of the anterior pelvic ring was observed in all cases. Our results show that percutaneous triangular stabilization of type 3 and type 4 fragility fractures of the pelvis usually leads to fracture healing. Radiological signs of loosening were observed in 62%, an implant removal due to symptomatic loosening was necessary in 23%.
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Affiliation(s)
| | - Jens Gulow
- Department of Spine Surgery, Helios Park-Klinikum Leipzig, Germany
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11
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Akhter S, Qureshi AR, El-Khechen HA, Bozzo A, Khan M, Patel R, Bhandari M, Aleem I. The efficacy of teriparatide on lumbar spine bone mineral density, vertebral fracture incidence and pain in post-menopausal osteoporotic patients: A systematic review and meta-analysis. Bone Rep 2020; 13:100728. [PMID: 33145376 PMCID: PMC7591342 DOI: 10.1016/j.bonr.2020.100728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 10/10/2020] [Accepted: 10/14/2020] [Indexed: 11/20/2022] Open
Abstract
Objective Teriparatide has been increasingly utilized in the management of osteoporosis. The efficacy of low and high dose teriparatide on lumbar spine bone mineral density, vertebral fracture incidence and pain is unknown. We sought to determine the efficacy of teriparatide on these patient-important outcomes using a systematic review and meta-analysis. Methods A systematic search of electronic databases (MEDLINE, EMBASE, CENTRAL, CINAHL) was performed to identify randomized controlled trials (RCTs) that evaluate teriparatide to any comparator for the treatment of osteoporosis in postmenopausal women. The Grades of Recommendation Assessment, Development and Evaluation (GRADE) criteria were used by two independent reviewers to assess the strength and quality of evidence. Results A total of 20 studies (n = 6024) were included in this review, with 2855 patients receiving teriparatide and 3169 patients receiving placebo or control treatment. A teriparatide dose of 20 μg/day increased lumbar spine bone mineral density (BMD) (standardized mean difference (SMD) 0.34 standard deviation (SD) units higher (95% CI 0.19–0.48 SDs higher) in comparison to placebo. Relative to anti-resorptive agents, 20 μg/day of teriparatide had a range from 0.14 SD units to 0.96 SD units higher (95% CI, 0.08 SDs lower to 0.36 SDs higher, CI, 0.33–1.59 SDs higher, respectively). 20 μg/day teriparatide had a significant effect on pain severity to placebo or control (SMD 0.80, 95% CI, 1.16–0.43 SDs lower) and also decreased the incidence of vertebral fractures compared to placebo (relative risk 0.31, 95% CI 0.21 to 0.46). Arthralgia and extremity pain incidence were also calculated; there were 15 and 8 fewer events per 1000 patients with the use of 20 μg/day of teriparatide compared to placebo or control, respectively. Conclusion High quality evidence supports the utilization of teriparatide 20 μg/day dose to significantly improve lumbar spine BMD and decrease incidence of vertebral fractures and pain severity relative to all comparators. 40 μg/day dose of teriparatide demonstrated significantly better results with prolonged treatment. This data is valuable for clinicians involved in the care of this growing demographic of patients. Further investigation on the safety and efficacy of teriparatide in higher doses for the long-term treatment of osteoporosis in postmenopausal women should be conducted through high-quality clinical trials. Teriparatide (20 μg/day) significantly improves lumbar spine bone mineral density. Teriparatide (20 μg/day) reduces vertebral fracture incidence and pain. Increased teriparatide dose (40 μg/day) may have even greater clinical efficacy. Further investigation on safety profiles for longer-term treatment is warranted.
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Affiliation(s)
- Shakib Akhter
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Canada.,Department of Orthopaedic Surgery, McMaster University, Canada
| | - Abdul Rehman Qureshi
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Canada
| | - Hussein Ali El-Khechen
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Canada
| | - Anthony Bozzo
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Canada.,Department of Orthopaedic Surgery, McMaster University, Canada
| | - Moin Khan
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Canada.,Department of Orthopaedic Surgery, McMaster University, Canada
| | - Rakesh Patel
- Department of Orthopaedic Surgery, University of Michigan, United States of America
| | - Mohit Bhandari
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Canada.,Department of Orthopaedic Surgery, McMaster University, Canada.,OrthoEvidence, Burlington, Ontario, Canada
| | - Ilyas Aleem
- Department of Orthopaedic Surgery, University of Michigan, United States of America
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Cheng SH, Kuo YJ, Chen C, Kang YN. Effects of teriparatide and bisphosphonate on spinal fusion procedure: A systematic review and network meta-analysis. PLoS One 2020; 15:e0237566. [PMID: 32870946 PMCID: PMC7462270 DOI: 10.1371/journal.pone.0237566] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 07/14/2020] [Indexed: 01/11/2023] Open
Abstract
Background Giving patients anti-osteoporotic agents peri-operatively is a well-accepted strategy to increase fusion rate and prevent complications. The purpose of this study was to investigate effectiveness of teriparatide and bisphosphonate on fusion surgery of thoracic and lumbar spine. Methods We searched EMBASE and PubMed for randomized clinical trials (RCTs) and prospective comparative studies using teriparatide or bisphosphonate in peri-operative spinal fusion surgery. Our synthesized data of fusion rate, Oswestry disability index (ODI), and adverse event in contrast-based network meta-analysis. Pooled results were presented in risk ratio (RR) or mean difference (MD) with 95% confidence interval (CI). Results Our search hit eight RCTs and three prospective studies with 676 patients receiving spinal surgery. Pooled result showed that teriparatide+Denosumab leads to significantly higher fusion rate than placebo (RR, 2.84; 95% CI: 1.22 to 6.60) and bisphosphonate (RR, 2.59; 95% CI: 1.13 to 5.96). We did not observe significant finding among placebo, teriparatide, and bisphosphonate in the two network models. Conclusion This is the first network meta-analysis providing an overview of the use of teriparatide and bisphosphonate for spinal fusion surgery. Teriparatide treatments are worth to be consider for spinal fusion surgery.
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Affiliation(s)
- Shih-Hao Cheng
- Department of Orthopedics, Wan Fang Hospital, Taipei Medical University, Taipei, Republic of China (Taiwan)
- Department of Orthopedics, Cheng Hsin General Hospital, Taipei, Republic of China (Taiwan)
| | - Yi-Jie Kuo
- Department of Orthopedics, Wan Fang Hospital, Taipei Medical University, Taipei, Republic of China (Taiwan)
- Department of Orthopedic Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Republic of China (Taiwan)
| | - Chiehfeng Chen
- Department of Public Health, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Republic of China (Taiwan)
- Cochrane Taiwan, Taipei Medical University, Taipei, Republic of China (Taiwan)
- Division of Plastic Surgery, Department of Surgery, Wan Fang Hospital, Taipei Medical University, Taipei, Republic of China (Taiwan)
- Evidence-Based Medicine Center, Wan Fang Hospital, Taipei Medical University, Taipei, Republic of China (Taiwan)
| | - Yi-No Kang
- Cochrane Taiwan, Taipei Medical University, Taipei, Republic of China (Taiwan)
- Evidence-Based Medicine Center, Wan Fang Hospital, Taipei Medical University, Taipei, Republic of China (Taiwan)
- Research Center of Big Data and Meta-Analysis, Wan Fang Hospital, Taipei Medical University, Taipei, Republic of China (Taiwan)
- Institute of Health Policy & Management, College of Public Health, National Taiwan University, Taipei, Republic of China (Taiwan)
- * E-mail:
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13
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Liu D, Qin H, Yang J, Yang L, He S, Chen S, Bao Q, Zhao Y, Zong Z. Different effects of Wnt/β-catenin activation and PTH activation in adult and aged male mice metaphyseal fracture healing. BMC Musculoskelet Disord 2020; 21:110. [PMID: 32075627 PMCID: PMC7031971 DOI: 10.1186/s12891-020-3138-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 02/12/2020] [Indexed: 12/25/2022] Open
Abstract
Background Fractures in older men are not uncommon and need to be healed as soon as possible to avoid related complications. Anti-osteoporotic drugs targeting Wnt/β-catenin and PTH (parathyroid hormone) to promote fracture healing have become an important direction in recent years. The study is to observe whether there is a difference in adult and aged situations by activating two signal paths. Methods A single cortical hole with a diameter of 0.6 mm was made in the femoral metaphysis of Catnblox(ex3) mice and wild-type mice. The fracture healing effects of CA (Wnt/β-catenin activation) and PTH (activated by PTH (1–34) injections) were assessed by X-ray and CT imaging on days 7, 14, and 21 after fracture. The mRNA levels of β-catenin, PTH1R(Parathyroid hormone 1 receptor), and RUNX2(Runt-related transcription factor 2) in the fracture defect area were detected using RT-PCR. Angiogenesis and osteoblasts were observed by immunohistochemistry and osteoclasts were observed by TRAP (Tartrate-resistant Acid Phosphatase). Result Adult CA mice and adult PTH mice showed slightly better fracture healing than adult wild-type (WT) mice, but there was no statistical difference. Aged CA mice showed better promotion of angiogenesis and osteoblasts and better fracture healing than aged PTH mice. Conclusion The application of Wnt/β-catenin signaling pathway drugs for fracture healing in elderly patients may bring better early effects than PTH signaling pathway drugs, but the long-term effects need to be observed.
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Affiliation(s)
- Daocheng Liu
- State Key Laboratory of Trauma, Burn and Combined Injury, Department of War Wound Rescue Skills Training, Base of Army Health Service Training, Army Medical University, Chongqing, 400042, China
| | - Hao Qin
- State Key Laboratory of Trauma, Burn and Combined Injury, Department of War Wound Rescue Skills Training, Base of Army Health Service Training, Army Medical University, Chongqing, 400042, China
| | - Jiazhi Yang
- State Key Laboratory of Trauma, Burn and Combined Injury, Department of War Wound Rescue Skills Training, Base of Army Health Service Training, Army Medical University, Chongqing, 400042, China
| | - Lei Yang
- State Key Laboratory of Trauma, Burn and Combined Injury, Department of War Wound Rescue Skills Training, Base of Army Health Service Training, Army Medical University, Chongqing, 400042, China
| | - Sihao He
- State Key Laboratory of Trauma, Burn and Combined Injury, Department of War Wound Rescue Skills Training, Base of Army Health Service Training, Army Medical University, Chongqing, 400042, China
| | - Sixu Chen
- State Key Laboratory of Trauma, Burn and Combined Injury, Department of War Wound Rescue Skills Training, Base of Army Health Service Training, Army Medical University, Chongqing, 400042, China
| | - Quanwei Bao
- State Key Laboratory of Trauma, Burn and Combined Injury, Department of War Wound Rescue Skills Training, Base of Army Health Service Training, Army Medical University, Chongqing, 400042, China
| | - Yufeng Zhao
- State Key Laboratory of Trauma, Burn and Combined Injury, Department of War Wound Rescue Skills Training, Base of Army Health Service Training, Army Medical University, Chongqing, 400042, China
| | - Zhaowen Zong
- State Key Laboratory of Trauma, Burn and Combined Injury, Department of War Wound Rescue Skills Training, Base of Army Health Service Training, Army Medical University, Chongqing, 400042, China.
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Canintika AF, Dilogo IH. Teriparatide for treating delayed union and nonunion: A systematic review. J Clin Orthop Trauma 2020; 11:S107-S112. [PMID: 31992929 PMCID: PMC6977176 DOI: 10.1016/j.jcot.2019.10.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 10/29/2019] [Accepted: 10/30/2019] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Fracture nonunion remains a great challenge for orthopaedic surgeons. Approximately 5-10% of bone fractures do not heal promptly, and require another surgical procedure. Previously, several small studies have found that teriparatide, a parathyroid hormone (PTH) analogue, has been found to induce union in those with delayed union and nonunion. However, to date, no systematic reviews regarding the use of teriparatide for delayed union and nonunion are available. The present review aims to investigate the safety and efficacy of teriparatide in delayed union and nonunion. METHODS Systematic literature search was performed in PubMed, ScienceDirect, and Google Scholar until September 26, 2019. We included studies involving adult patients (age >16 years) diagnosed with delayed union or nonunion fracture regardless of location (long bone, short bone, flat bone or irregular bone). The language was restricted to English and Indonesian. Outcomes that were recorded were fracture union and adverse events. RESULTS Initial search found 5416 abstract and titles. Of these, 20 articles consisting of 64 subjects were retrieved. Of these, 15 case reports, 4 case series, and one prospective study were included. All of the studies administered subcutaneous injection of teriparatide 20 μg/day with mean duration of 7.3 ± 1.5 weeks to 9.7 months. Sixty-one (95.3%) of 64 subjects developed complete union. The follow-up ranged from 3 to 24 months. No side effects occurred during the follow-up period. CONCLUSIONS Limited evidence demonstrates that daily subcutaneous injection of teriparatide 20 μg is a potential new safe treatment for delayed union and nonunion with no side effects. We highly suggest the use of such drug, as it is highly effective and safe. However, further clinical studies are required to investigate its safety and efficacy.
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Affiliation(s)
- Anissa Feby Canintika
- Department of Orthopaedics and Traumatology, Faculty of Medicine-Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
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15
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Zandi M, Dehghan A, Bigonah N, Doulati S, Mohammad Gholi Mezerji N. Histological assessment of the effects of teriparatide therapy on mandibular fracture healing: A preclinical study. J Craniomaxillofac Surg 2020; 48:211-216. [PMID: 32014386 DOI: 10.1016/j.jcms.2020.01.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 12/31/2019] [Accepted: 01/13/2020] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVE This study was performed to evaluate the effects of teriparatide therapy on mandibular fracture healing in a rat model. SUBJECTS AND METHODS A unilateral mandibular fracture, 5 mm posterior to the last molar tooth, was surgically created in 120 rats. Half of the animals received a daily subcutaneous injection of 2 μg/kg teriparatide while the control rats received normal saline, starting from the day of surgery until sacrifice. Twenty rats from each group were sacrificed on postoperative days 10, 20, and 30. The healing process was evaluated histologically and scored using a grading system (ranging from 1 to 10). RESULTS On day 10 the fracture gaps of the control and teriparatide groups were mainly filled with fibrous tissue and new trabecular bone, respectively. On day 20 a large amount of new trabecular bone and some areas of fibrocartilaginous tissue were seen in the fracture gaps of the control rats. In the teriparatide group the fracture area was entirely filled with trabecular bone, which in some areas had been replaced by mature bone. On day 30 the fracture gaps of the control group were entirely bridged by new trabecular bone, while in the teriparatide group they was predominantly filled with mature bone. At all three time-points the mean healing scores for the teriparatide group (6.20 ± 0.70, 8.50 ± 0.69, and 9.85 ± 0.37, respectively) were significantly higher (p < 0.001) than for the control group (4.90 ± 0.55, 7.15 ± 0.59, and 8.90 ± 0.64, respectively). CONCLUSION Based on the results of this study, teriparatide should be tested in humans in order to establish whether comparable results can be achieved.
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Affiliation(s)
- Mohammad Zandi
- Department of Oral and Maxillofacial Surgery, Hamadan University of Medical Sciences, Hamadan, Iran; Dental Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Arash Dehghan
- Department of Pathology, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Nemat Bigonah
- Department of Oral and Maxillofacial Surgery, Hamadan University of Medical Sciences, Hamadan, Iran.
| | - Shideh Doulati
- Dental Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
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Ban ZN, Li ZJ, Gu QS, Cheng J, Huang Q, Xing SX. Correlation of serum PTH level and fracture healing speed in elderly patients with hip fracture. J Orthop Surg Res 2019; 14:361. [PMID: 31718681 PMCID: PMC6852715 DOI: 10.1186/s13018-019-1413-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 10/14/2019] [Indexed: 01/23/2023] Open
Abstract
Purpose To access serum parathyroid hormone (PTH) level in elderly patients with hip fracture in relation to fracture healing outcomes. Methods This study included 90 elderly male patients with hip fracture and they were defined as the hip fracture group, and they were divided into healing effective group and delayed healing group by final fracture healing outcomes, 45 cases in each group; another 45 male patients older than 70 years without established osteoporosis and hip fracture were included as the control group. The levels of serum PTH level were examined in each group. Results Serum PTH level was significantly higher in healing effective group patients at the 7 days and 14 days after fracture than the delayed healing patients. Conclusions Our results show that serum PTH level may be an effective indicator of hip fracture delayed healing risk in the elderly.
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Affiliation(s)
- Zhao-Nan Ban
- Department of Orthopedics, Chengdu Fifth People's Hospital, No.33 Ma Shi Street, Wen jiang District, Chengdu, 611130, Sichuan Province, People's Republic of China
| | - Zheng-Jiang Li
- Department of Orthopedics, Chengdu Fifth People's Hospital, No.33 Ma Shi Street, Wen jiang District, Chengdu, 611130, Sichuan Province, People's Republic of China
| | - Qi-Shan Gu
- Department of Orthopedics, Chengdu Fifth People's Hospital, No.33 Ma Shi Street, Wen jiang District, Chengdu, 611130, Sichuan Province, People's Republic of China
| | - Jun Cheng
- Department of Orthopedics, Chengdu Fifth People's Hospital, No.33 Ma Shi Street, Wen jiang District, Chengdu, 611130, Sichuan Province, People's Republic of China
| | - Qiang Huang
- Department of Orthopedics, Chengdu Fifth People's Hospital, No.33 Ma Shi Street, Wen jiang District, Chengdu, 611130, Sichuan Province, People's Republic of China
| | - Shu-Xing Xing
- Department of Orthopedics, Chengdu Fifth People's Hospital, No.33 Ma Shi Street, Wen jiang District, Chengdu, 611130, Sichuan Province, People's Republic of China.
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Kim SJ, Park HS, Lee DW, Lee JW. Does short-term weekly teriparatide improve healing in unstable intertrochanteric fractures? J Orthop Surg (Hong Kong) 2019; 26:2309499018802485. [PMID: 30296889 DOI: 10.1177/2309499018802485] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
UNLABELLED Slow recovery after hip fracture has been associated with negative consequences. Thus, there is medical need to improve healing and functional recovery after intertrochanteric fracture. The aim of this study was to measure whether short-term teriparatide would improve healing in intertrochanteric fractures after internal fixation as measured by (1) clinical scores, (2) radiographic fracture healing, and (3) complication rates. We retrospectively reviewed 96 patients (average age, 82 years) who underwent closed reduction and internal fixation with proximal femoral nail (PFN) for unstable intertrochanteric fractures between 2014 and 2016. Of the 96 patients, 56 patients were treated with a PFN alone (group 1). These patients were compared with 46 patients for whom the same device was used and a weekly subcutaneous injection of PTH 1-34 (teriparatide) was prescribed postoperatively (group 2). Questionnaire surveys or telephone interviews were conducted, and patients completed a self-report Harris hip score and visual analog scale scores. The radiological time to fracture healing was assessed as the primary end point. Postoperative complication rates were compared. Functional outcomes at 6 months after surgery were similar in both groups. There were no differences between groups in the proportion of patients achieving radiographic fracture healing. The frequency of patients reporting adverse events was 20% (10 of 50) in group 1 versus 17% (8 of 46) in group 2 ( p = 0.744). Short-term teriparatide did not improve radiographic signs of fracture healing of an intertrochanteric fracture and reduce the incidence of complications. The effect of teriparatide on fracture healing remains uncertain. Further multicenter prospective studies are needed to demonstrate objective long-term results of parathyroid hormone therapy in patient with hip fracture. LEVEL OF EVIDENCE Level IV, therapeutic study.
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Affiliation(s)
- Seung-Ju Kim
- Department of Orthopaedics, Hanil General Hospital, Seoul, Korea
| | - Hyun-Soo Park
- Department of Orthopaedics, Hanil General Hospital, Seoul, Korea
| | - Dong-Woo Lee
- Department of Orthopaedics, Hanil General Hospital, Seoul, Korea
| | - Jae-Won Lee
- Department of Orthopaedics, Hanil General Hospital, Seoul, Korea
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Abstract
As a result of immense heterogeneity with regard to morphology and stability, the recent literature lacks consensus concerning the treatment of sacral insufficiency fractures. We report the case of a 79-year-old woman with bilateral sacral insufficiency fractures following anterior pelvic ring fractures who was treated with teriparatide. During a two-week hospital stay, the patient was successfully mobilised and the regularly conducted pelvic X‑ray controls showed full consolidation of the fractures.
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Kim SJ, Park HS, Lee DW, Lee JW. Short-term daily teriparatide improve postoperative functional outcome and fracture healing in unstable intertrochanteric fractures. Injury 2019; 50:1364-1370. [PMID: 31182230 DOI: 10.1016/j.injury.2019.06.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 03/25/2019] [Accepted: 06/02/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND There has been heightened interest in the effect of osteoanabolic agents on acceleration of fracture healing. OBJECTIVES The purpose of this study was to identify whether short-term daily teriparatide prescribed for osteoporosis treatment would improve postoperative outcomes including clinical scores, radiographic healing, and complication rates. METHODS Between 2014 and 2017, we retrospectively assessed 112 patients who underwent closed reduction and internal fixation with proximal femoral nail (PFN) for unstable intertrochanteric fractures. In 60 of 112 patients, patients were treated with a PFN alone (group I). These patients were compared with 52 patients for whom the same device was used and a daily subcutaneous injection of teriparatide (1-34 PTH, Forsteo®) was prescribed postoperatively (group II). Teriparatide was administered by nurses during a hospital stay and then self-injection was monitored by follow-up visits to the outpatient clinic after discharge. Questionnaire surveys were conducted and patients completed a self-report Harris hip score (HHS) and visual analog scale (VAS) scores. RESULTS Teriparatide therapy significantly increased HHS (p = 0.02) and decreased VAS pain scores (p = 0.008). The mean time to fracture healing post-operatively was 14.8 weeks (SD 7.1) and 12.1 weeks (SD 6.4) in group I and II, respectively (p = 0.002). The frequency of patients reporting postoperative complications was also markedly reduced in the teriparatide-treated groups (p = 0.028). CONCLUSIONS Short-term daily teriparatide used for osteoporosis treatment improved radiographic fracture healing of a hip fracture and reduced complication rates. However, because of the limited power of the study, additional randomized placebo-controlled trials are needed to determine the potential benefit of PTH as an adjunct to enhance fracture healing and its efficacy in broader populations with varying comorbidities and fracture types.
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Affiliation(s)
- Seung-Ju Kim
- Department of Orthopaedics, Hanil General Hospital, 308 Uicheon-ro, Dobong-Gu, Seoul 132-703, South Korea.
| | - Hyun-Soo Park
- Department of Orthopaedics, Hanil General Hospital, 308 Uicheon-ro, Dobong-Gu, Seoul 132-703, South Korea.
| | - Dong-Woo Lee
- Department of Orthopaedics, Hanil General Hospital, 308 Uicheon-ro, Dobong-Gu, Seoul 132-703, South Korea.
| | - Jae-Won Lee
- Department of Orthopaedics, Hanil General Hospital, 308 Uicheon-ro, Dobong-Gu, Seoul 132-703, South Korea.
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Casado-Díaz A, Dorado G, Giner M, Montoya MJ, Navarro-Valverde C, Díez-Pérez A, Quesada-Gómez JM. Proof of Concept on Functionality Improvement of Mesenchymal Stem-Cells, in Postmenopausal Osteoporotic Women Treated with Teriparatide (PTH1-34), After Suffering Atypical Fractures. Calcif Tissue Int 2019; 104:631-640. [PMID: 30725167 DOI: 10.1007/s00223-019-00533-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 01/30/2019] [Indexed: 12/30/2022]
Abstract
Osteoporosis long-term treatment with nitrogen-containing bisphosphonates, has been associated with uncommon adverse effects, as atypical femoral fractures (AFF). Thus, treatment with teriparatide (TPTD; fragment of human parathyroid hormone; PTH1-34) has been proposed for such patients. Besides its anabolizing effect on bone, TPTD may affect stem-cell mobilization and expansion. Bone marrow mononuclear cells (BMMNC) were isolated from five women that had suffered AFF associated to bisphosphonate treatment, before and after 6 months of TPTD therapy. The presence of mesenchymal stromal cells (CD73, CD90 and CD105 positive cells), gene expression of NANOG, SOX2 and OCT4, proliferation, senescence and capacity to differentiate into osteoblasts and adipocytes were analyzed. After TPTD treatment, BMMNC positive cells for CD73, CD90 and CD105 increased from 6.5 to 37.5% (p < 0.05); NANOG, SOX2 and OCT4 were upregulated, being statistically significant for NANOG (p < 0.05), and cells increased proliferative capacity more than 50% at day 7 (p < 0.05). Senescence was reduced 2.5-fold (p < 0.05), increasing differentiation capacity into osteoblasts and adipocytes, with more than twice mineralization capacity of extracellular matrix or fat-droplet formation (p < 0.05), respectively. Results show that TPTD treatment caused BMMNC "rejuvenation", increasing the number of cells in a more undifferentiated stage, with higher differentiation potency. This effect may favor TPTD anabolic action on bone in such patients with AFF, increasing osteoblast precursor cells. Such response could also arise in other osteoporotic patients treated with TPTD, without previous AFF. Furthermore, our data suggest that TPTD effect on stromal cells may have clinical implications for bone-regenerative medicine. Further studies may deepen on this potential.
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Affiliation(s)
- Antonio Casado-Díaz
- Unidad de Gestión Clínica de Endocrinología y Nutrición, CIBER de Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Hospital Universitario Reina Sofía, RETICEF, 14004, Córdoba, Spain
| | - Gabriel Dorado
- Dep. Bioquímica y Biología Molecular, Campus Rabanales C6-1-E17, Campus de Excelencia Internacional Agroalimentario (ceiA3), Universidad de Córdoba, RETICEF CIBERFES, 14071, Córdoba, Spain
| | - Mercè Giner
- Dep. de Medicina Interna, Dept. de Histología y Citología Normal y Patológica, Escuela de Medicina, Unidad de Metabolismo óseo, Hospital Universitario Virgen Macarena, Universidad de Sevilla, RETICEF, 41009, Seville, Spain
| | - María José Montoya
- Dept. de Medicina, Escuela de Medicina, Universidad de Sevilla, RETICEF, 41009, Seville, Spain
| | - Cristina Navarro-Valverde
- Unidad de Gestión Clínica de Cardiología, Hospital Universitario Virgen de Valme, 41014, Seville, Spain
| | - Adolfo Díez-Pérez
- Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Universitat Autònoma de Barcelona, RETICEF, CIBERFES, 08003, Barcelona, Spain
| | - José Manuel Quesada-Gómez
- Unidad de Gestión Clínica de Endocrinología y Nutrición, CIBER de Fragilidad y Envejecimiento Saludable (CIBERFES), Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Hospital Universitario Reina Sofía, RETICEF, 14004, Córdoba, Spain.
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Zandi M, Dehghan A, Amini P, Doulati S, Rezaeian L. Evaluation of the effect of teriparatide therapy on mandibular fracture healing in rats with medication-related osteonecrosis of the jaw. Clin Oral Investig 2019; 23:3987-3993. [DOI: 10.1007/s00784-019-02830-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 01/25/2019] [Indexed: 10/27/2022]
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Tsuchie H, Miyakoshi N, Iba K, Kasukawa Y, Nozaka K, Dohke T, Kosukegawa I, Aizawa T, Maekawa S, Abe H, Takeshima M, Tomite T, Segawa T, Ouchi K, Kinoshita H, Suzuki M, Yamashita T, Shimada Y. The effects of teriparatide on acceleration of bone healing following atypical femoral fracture: comparison between daily and weekly administration. Osteoporos Int 2018; 29:2659-2665. [PMID: 30105400 DOI: 10.1007/s00198-018-4658-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 08/06/2018] [Indexed: 12/17/2022]
Abstract
UNLABELLED We compared the effectiveness of promoting bone healing between two teriparatide preparations for atypical femoral fracture (AFF). A total of 45 AFFs were included in this study, and we compared the duration of bone union. Teriparatide administered by daily injection enhanced bone union more than weekly administration in complete AFFs. INTRODUCTION The efficacy of teriparatide for atypical femoral fracture (AFF) has been recently reported. Although two different teriparatide preparations can be used to treat osteoporosis in Japan, daily or weekly injection, all previous reports on the effectiveness of teriparatide for AFF only examined daily injection formulations. Therefore, we compared the promotion of bone healing between the two teriparatide preparations for AFF. METHODS A total of 45 consecutive AFFs in 43 Japanese patients were included in this study. They received either a daily 20-μg teriparatide injection (daily group; n = 32) or a once-a-week 56.5-μg teriparatide injection (weekly group; n = 13). We compared the clinical background and duration of bone union between these two groups. RESULTS When all patents were included, the fracture healing time was not significantly different between the two groups. Only patients with complete AFFs had significantly fewer daily bisphosphonate or denosumab injections than the weekly group (P < 0.05). The fracture healing time in the daily group (6.1 ± 4.1 months) was significantly shorter than that in the weekly group (10.1 ± 4.2 months) (P < 0.05). Even if the influence of bisphosphonate or denosumab usage was excluded, a similar significant difference was observed in the fracture healing time (P < 0.05). There was no significant difference between the two groups among patients with incomplete AFFs. CONCLUSIONS Daily teriparatide injections enhance bone union more than weekly injections in complete AFF patients.
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Affiliation(s)
- H Tsuchie
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan.
| | - N Miyakoshi
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan
| | - K Iba
- Department of Orthopedic Surgery, Sapporo Medical University School of Medicine, S-1 W-16, Cyuo-ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Y Kasukawa
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan
| | - K Nozaka
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan
| | - T Dohke
- Department of Orthopedic Surgery, Sapporo Medical University School of Medicine, S-1 W-16, Cyuo-ku, Sapporo, Hokkaido, 060-8543, Japan
| | - I Kosukegawa
- Department of Orthopedic Surgery, Sapporo Medical University School of Medicine, S-1 W-16, Cyuo-ku, Sapporo, Hokkaido, 060-8543, Japan
| | - T Aizawa
- Department of Orthopedic Surgery, Northern Akita Municipal Hospital, 16-29 Shimosugi aza Kamishimizusawa, Kitaakita, 018-4221, Japan
| | - S Maekawa
- Department of Orthopedic Surgery, Ogachi Central Hospital, 25 Yamada aza Isamigaoka, Yuzawa, 012-0055, Japan
| | - H Abe
- Department of Orthopedic Surgery, Ugo Municipal Hospital, 44-5 Otomichi, Nishomonai, Ugo, 012-1131, Japan
| | - M Takeshima
- Department of Orthopedic Surgery, Honjyo Daiichi Hospital, 111 Iwabuchishita, Yurihonjyo, 015-8567, Japan
| | - T Tomite
- Department of Orthopedic Surgery, Japanese Red Cross Akita Hospital, 222-1 Saruta aza Inawashirosawa, Kamikitate, Akita, 010-1495, Japan
| | - T Segawa
- Department of Orthopedic Surgery, Akita City Hospital, 4-30 Matsuokamachi, Kawamoto, Akita, 010-0933, Japan
| | - K Ouchi
- Department of Orthopedic Surgery, Yokote Municipal Hospital, 5-31 Negishimachi, Yokote, 013-8602, Japan
| | - H Kinoshita
- Department of Orthopedic Surgery, Akita Kousei Medical Center, 1-1-1 Iijima, Nishifukuro, Akita, 011-0948, Japan
| | - M Suzuki
- Department of Orthopedic Surgery, Yuri Kumiai General Hospital, Kawaguchi aza Yaushiro, Yurihonjyo, 015-8511, Japan
| | - T Yamashita
- Department of Orthopedic Surgery, Sapporo Medical University School of Medicine, S-1 W-16, Cyuo-ku, Sapporo, Hokkaido, 060-8543, Japan
| | - Y Shimada
- Department of Orthopedic Surgery, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan
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Rausch V, Seybold D, Königshausen M, Köller M, Schildhauer TA, Geßmann J. [Basic principles of fracture healing]. DER ORTHOPADE 2018; 46:640-647. [PMID: 28718007 DOI: 10.1007/s00132-017-3449-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND In contrast to other tissues, bone has the remarkable ability to heal without scarring. After union of the fracture, the remodeled bone ideally does not differ from the original bone, especially in terms of biomechanical properties. The healing of a fracture resembles the embryonic development of bone. Depending on the biomechanical properties of the fracture, bone heals directly or indirectly, which refers to the formation of cartilage as a step before new bone appears. Currently, treatment of the patient is often limited to anatomical reduction and optimization of the fracture environment with respect to biomechanics. PROSPECTS Future treatment strategies, however, could include systemic medication that could be especially beneficial for patients at risk of complications in fracture healing. The aim of this review is to provide an overview on the process of fracture healing and to depict possibilities for current and future treatment strategies.
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Affiliation(s)
- Valentin Rausch
- Chirurgische Universitätsklinik und Poliklinik, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Deutschland
| | - Dominik Seybold
- Chirurgische Universitätsklinik und Poliklinik, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Deutschland.
| | - Matthias Königshausen
- Chirurgische Universitätsklinik und Poliklinik, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Deutschland
| | - Manfred Köller
- Chirurgische Universitätsklinik und Poliklinik, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Deutschland
| | - Thomas A Schildhauer
- Chirurgische Universitätsklinik und Poliklinik, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Deutschland
| | - Jan Geßmann
- Chirurgische Universitätsklinik und Poliklinik, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Bürkle-de-la-Camp-Platz 1, 44789, Bochum, Deutschland
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Liu Y, Jia Z, Akhter MP, Gao X, Wang X, Wang X, Zhao G, Wei X, Zhou Y, Wang X, Hartman CW, Fehringer EV, Cui L, Wang D. Bone-targeting liposome formulation of Salvianic acid A accelerates the healing of delayed fracture Union in Mice. NANOMEDICINE-NANOTECHNOLOGY BIOLOGY AND MEDICINE 2018; 14:2271-2282. [PMID: 30076934 DOI: 10.1016/j.nano.2018.07.011] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 06/13/2018] [Accepted: 07/24/2018] [Indexed: 12/29/2022]
Abstract
Delayed fracture union is a significant clinical challenge in orthopedic practice. There are few non-surgical therapeutic options for this pathology. To address this challenge, we have developed a bone-targeting liposome (BTL) formulation of salvianic acid A (SAA), a potent bone anabolic agent, for improved treatment of delayed fracture union. Using pyrophosphorylated cholesterol as the targeting ligand, the liposome formulation (SAA-BTL) has demonstrated strong affinity to hydroxyapatite in vitro, and to bones in vivo. Locally administered SAA-BTL was found to significantly improve fracture callus formation and micro-architecture with accelerated mineralization rate in callus when compared to the dose equivalent SAA, non-targeting SAA liposome (SAA-NTL) or no treatment on a prednisone-induced delayed fracture union mouse model. Biomechanical analyses further validated the potent therapeutic efficacy of SAA-BTL. These results support SAA-BTL formulation, as a promising therapeutic candidate, to be further developed into an effective and safe clinical treatment for delayed bone fracture union.
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Affiliation(s)
- Yanzhi Liu
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Nebraska Medical Center, Omaha, NE, USA; Guangdong Key laboratory for Research and Development of Natural Drugs, Guangdong Medical University, Zhanjiang, Guangdong, China
| | - Zhenshan Jia
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Nebraska Medical Center, Omaha, NE, USA
| | | | - Xiang Gao
- Stem Cell research and Cellular Therapy Center, Affiliated Hospital of Guangdong Medical University, Zhanjiang, Guangdong, China
| | - Xiaobei Wang
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Nebraska Medical Center, Omaha, NE, USA
| | - Xiaoyan Wang
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Nebraska Medical Center, Omaha, NE, USA
| | - Gang Zhao
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Nebraska Medical Center, Omaha, NE, USA
| | - Xin Wei
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Nebraska Medical Center, Omaha, NE, USA
| | - You Zhou
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Nebraska Medical Center, Omaha, NE, USA
| | - Xiuli Wang
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Nebraska Medical Center, Omaha, NE, USA
| | - Curtis W Hartman
- Department of Orthopaedic Surgery and Rehabilitation, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Edward V Fehringer
- Columbus Community Hospital Orthopedics & Sports Medicine Clinic, Columbus, NE, USA
| | - Liao Cui
- Guangdong Key laboratory for Research and Development of Natural Drugs, Guangdong Medical University, Zhanjiang, Guangdong, China.
| | - Dong Wang
- Department of Pharmaceutical Sciences, College of Pharmacy, University of Nebraska Medical Center, Omaha, NE, USA.
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Kastirr I, Reichardt M, Andresen R, Radmer S, Schröder G, Westphal T, Mittlmeier T, Schober HC. Therapy of aseptic nonunions with parathyroid hormone. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2018; 29:169-173. [PMID: 29931529 PMCID: PMC6331490 DOI: 10.1007/s00590-018-2269-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 06/15/2018] [Indexed: 12/11/2022]
Abstract
The absence of osseous consolidation of a fracture for 9 or more months with no potential to heal is defined as nonunion. Both for the patient and from a socioeconomic point of view, nonunions represent a major problem. Hypertrophic, vital nonunions are distinguished from atrophic avital ones. Risk factors for a delayed fracture healing are insufficient immobilisation, poor adaptation of the fracture surfaces or residual instability, interposition of soft tissue within the fracture gap, as well as circulation disturbances and infections. The incidence of nonunions after fractures of the long bones lies between 2.6 and 16% depending on the surgical technique used. In human and animal studies, a positive effect of parathyroid hormone (PTH) on fracture healing has been shown. PTH has a direct stimulatory effect on osteoblasts and osteoclasts. In addition, it appears to influence the effect of osseous growth factors. In this prospective study, 32 patients with nonunions were treated with teriparatide to investigate the effects of PTH on fracture healing. Definitive healing of the nonunions following PTH treatment could be observed in 95% of the cases.
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Affiliation(s)
- I Kastirr
- Institute of Diagnostic and Interventional Radiology/Neuroradiology, Westkuestenklinikum Heide, Academic Teaching Hospital of the Universities of Kiel, Lübeck and Hamburg, Esmarchstr. 50, 25746, Heide, Germany.
| | - M Reichardt
- Department of Internal Medicine I, Municipal Hospital Suedstadt Rostock, Academic Teaching Hospital of the University of Rostock, Rostock, Germany
| | - R Andresen
- Institute of Diagnostic and Interventional Radiology/Neuroradiology, Westkuestenklinikum Heide, Academic Teaching Hospital of the Universities of Kiel, Lübeck and Hamburg, Esmarchstr. 50, 25746, Heide, Germany
| | - S Radmer
- Center of Orthopaedics, Berlin, Germany
| | - G Schröder
- Department of Internal Medicine I, Municipal Hospital Suedstadt Rostock, Academic Teaching Hospital of the University of Rostock, Rostock, Germany
| | - T Westphal
- Clinic of Trauma Surgery, Orthopaedics and Hand Surgery, Municipal Hospital Suedstadt Rostock, Academic Teaching Hospital of the University of Rostock, Rostock, Germany
| | - T Mittlmeier
- Clinic of Trauma, Hand- and Reconstructive Surgery, Rostock University, Medical Center, Rostock, Germany
| | - H C Schober
- Department of Internal Medicine I, Municipal Hospital Suedstadt Rostock, Academic Teaching Hospital of the University of Rostock, Rostock, Germany
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Garg B, Batra S, Dixit V. An unexpected healing of an established non union of the radial neck through teriparatide: A case report and review of literature. J Clin Orthop Trauma 2018; 9:S103-S105. [PMID: 29628709 PMCID: PMC5883921 DOI: 10.1016/j.jcot.2017.10.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 07/13/2017] [Accepted: 10/26/2017] [Indexed: 10/18/2022] Open
Affiliation(s)
- Bhavuk Garg
- All India Institute of Medical Sciences, New Delhi, India
| | - Sahil Batra
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, 110029, India,Corresponding author.
| | - Vivek Dixit
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, 110029, India
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Kumabe Y, Lee SY, Waki T, Iwakura T, Takahara S, Arakura M, Kuroiwa Y, Fukui T, Matsumoto T, Matsushita T, Nishida K, Kuroda R, Niikura T. Triweekly administration of parathyroid hormone (1-34) accelerates bone healing in a rat refractory fracture model. BMC Musculoskelet Disord 2017; 18:545. [PMID: 29268728 PMCID: PMC5740882 DOI: 10.1186/s12891-017-1917-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Accepted: 12/14/2017] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Some reports have shown that intermittent parathyroid hormone (PTH) (1-34) treatment for patients with delayed union or nonunion have led to successful healing. In this study, we investigated whether systemic intermittent administration of PTH (1-34) has a beneficial effect on bone healing in a rat refractory fracture model. METHODS We created a refractory femoral fracture model in 32 rats with periosteal cauterization that leads to atrophic nonunion at 8 weeks after surgery. Half the rats received subcutaneous intermittent human PTH (1-34) injections at a dosage of 100 μg/kg, thrice a week for 8 weeks. The other half received the vehicle only. At 8 weeks after fracture, radiographic, histological and mechanical assessments were performed. RESULTS Radiographic assessments showed that the union rate was significantly higher in the PTH group than in the control group (P < 0.05). The degree of fracture repair as scored using the Allen grading system in histological assessment was significantly greater in the PTH group than in the control group (P < 0.05). The ultimate stress and stiffness measurements were significantly greater in the PTH group than in the control group (p < 0.05). CONCLUSIONS We demonstrated that triweekly administration of PTH (1-34) increased union rate and accelerated bone healing in a rat refractory fracture model, suggesting that systemic administration of PTH (1-34) could become a novel and useful therapy for accelerating fracture healing in patients at high risk of delayed union or nonunion.
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Affiliation(s)
- Yohei Kumabe
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Sang Yang Lee
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.,Department of Orthopaedic Surgery, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8666, Japan
| | - Takahiro Waki
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Takashi Iwakura
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Shunsuke Takahara
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Michio Arakura
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Yu Kuroiwa
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Tomoaki Fukui
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Tomoyuki Matsumoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Takehiko Matsushita
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Kotaro Nishida
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | - Takahiro Niikura
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
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Yeh WL, Su CY, Chang CW, Chen CH, Fu TS, Chen LH, Lin TY. Surgical outcome of atypical subtrochanteric and femoral fracture related to bisphosphonates use in osteoporotic patients with or without teriparatide treatment. BMC Musculoskelet Disord 2017; 18:527. [PMID: 29237448 PMCID: PMC5729282 DOI: 10.1186/s12891-017-1878-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 11/28/2017] [Indexed: 11/19/2022] Open
Abstract
Background Atypical subtrochanteric fracture and femoral fracture have been considered to be rare complications related to long-term bisphosphonates use. A reduced bone turnover rate may lead to delayed bone healing. Limited data have revealed that teriparatide treatment may reverse the effect of bisphosphonates and be effective in bone healing. Methods We reviewed patients with atypical subtrochanteric and femoral fracture related to bisphosphonates use between January 2008 and December 2014. Thirteen female patients were enrolled. Radiographic findings were compatible with the characteristics of atypical fracture. Surgical intervention was performed for all, and teriparatide use was advised postoperatively. Outcome measures included perioperative results, and clinical and radiographic outcome. Results Of the 13 female patients enrolled, 10 had subtrochanteric and 6 had proximal femoral fracture; 3 had bilateral fractures. The mean age of the patients at surgery was 70.15±6.36 years. Most fractures (68.8%) presented prodromal thigh pain. All patients were treated with an intramedullary fixation system without severe complications. The patients were divided into 2 groups based on whether they had received treatment with teriparatide or not. The mean time to bone union was 4.4 months in the teriparatide-treated group, and 6.2 months in the non-teriparatide-treated group (p=0.116). Six patients (75%) in the teriparatide-treated group and 4 (50%) in the non-teriparatide-treated group (p= 0.3) achieved bone union within 6 months. The means of the modified Harris Hip Score and Numerical Rating Scale were significantly better in the teriparatide-treated group at postoperative 6 months. Seven patients had the same ability to walk at the 1-year follow-up as they did before the atypical fracture. Conclusions Teriparatide treatment in patients with atypical fracture may help in fracture healing, hip function recovery, and pain relief in this reduced bone turnover patient group.
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Affiliation(s)
| | | | - Chia-Wei Chang
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Keelung branch, Bone and Joint Research Center, and Chang Gung University,, Taiwan, F7, No 222 Mai-King Road, Keelung, Taiwan
| | - Chien-Hao Chen
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Keelung branch, Bone and Joint Research Center, and Chang Gung University,, Taiwan, F7, No 222 Mai-King Road, Keelung, Taiwan
| | - Tsai-Sheng Fu
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Keelung branch, Bone and Joint Research Center, and Chang Gung University,, Taiwan, F7, No 222 Mai-King Road, Keelung, Taiwan
| | - Lih-Huei Chen
- Department of Orthopedic Surgery, Division of Trauma, Chang Gung Memorial Hospital, Linkou branch, Bone and Joint Research Center and Chang Gung University, Taoyuan, Taiwan
| | - Tung-Yi Lin
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Keelung branch, Bone and Joint Research Center, and Chang Gung University,, Taiwan, F7, No 222 Mai-King Road, Keelung, Taiwan.
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Kaneko T, Okamura K, Yonemoto Y, Okura C, Suto T, Tachibana M, Tamura Y, Inoue M, Chikuda H. Short-term daily teriparatide in patients with rheumatoid arthritis. Mod Rheumatol 2017; 28:468-473. [PMID: 28805099 DOI: 10.1080/14397595.2017.1362093] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The aim of this study was to compare the efficacy of six-month teriparatide treatment followed by six-month bisphosphonate therapy with 12-month bisphosphonate monotherapy in Japanese rheumatoid arthritis (RA) patients who had not been previously treated for osteoporosis. METHODS A total of 34 RA patients with osteoporosis were enrolled. Thirteen patients received six-month teriparatide prior to six-month minodronate therapy (PTH group), and 21 patients received 12-month minodronate therapy (BP group). Bone mineral density (BMD), and bone turnover markers were measured prior to and 6 and 12 months after the initiation of treatment. RESULTS Bone mineral density of the spine was significantly increased after 12 months of treatment in both groups. In the PTH group, the mean percent change of BMD of the spine was significantly higher at 12 months after the initiation of treatment, as compared to the BP group (PTH group: 9.9 ± 1.5%, BP group: 5.5 ± 0.7%). Femoral neck BMD was significantly increased only in the PTH group after 12 months. CONCLUSION Therapy involving six-month teriparatide followed by six-month minodronate therapy increased spine BMD to a greater degree than 12-month minodronate monotherapy. The strategy of short-term administration of teriparatide for RA patients with osteoporosis might be useful when additional bisphosphonate therapy is considered.
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Affiliation(s)
- Tetsuya Kaneko
- a Department of Orthopedic Surgery , Japan Redcross Society Fukaya Redcross Hospital , Fukaya , Saitama , Japan.,b Department of Orthopedic Surgery , Gunma University Graduate School of Medicine , Maebashi , Gunma , Japan.,c Department of Orthopedic Surgery , Fukaya Seikeigeka Clinic , Fukaya , Saitama , Japan.,d Department of Orthopedic Surgery , Inoue Hospital , Takasaki , Gunma , Japan
| | - Koichi Okamura
- b Department of Orthopedic Surgery , Gunma University Graduate School of Medicine , Maebashi , Gunma , Japan
| | - Yukio Yonemoto
- b Department of Orthopedic Surgery , Gunma University Graduate School of Medicine , Maebashi , Gunma , Japan
| | - Chisa Okura
- b Department of Orthopedic Surgery , Gunma University Graduate School of Medicine , Maebashi , Gunma , Japan
| | - Takahito Suto
- b Department of Orthopedic Surgery , Gunma University Graduate School of Medicine , Maebashi , Gunma , Japan
| | - Masahiro Tachibana
- b Department of Orthopedic Surgery , Gunma University Graduate School of Medicine , Maebashi , Gunma , Japan
| | - Yasuyuki Tamura
- d Department of Orthopedic Surgery , Inoue Hospital , Takasaki , Gunma , Japan
| | - Makoto Inoue
- d Department of Orthopedic Surgery , Inoue Hospital , Takasaki , Gunma , Japan
| | - Hirotaka Chikuda
- b Department of Orthopedic Surgery , Gunma University Graduate School of Medicine , Maebashi , Gunma , Japan
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Xiaofeng L, Daxia X, Yunzhen C. Teriparatide as a nonoperative treatment for tibial and femoral fracture nonunion: A case report. Medicine (Baltimore) 2017; 96:e6571. [PMID: 28422848 PMCID: PMC5406064 DOI: 10.1097/md.0000000000006571] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
RATIONALE Fracture nonunion is a great challenge for orthopedic surgeons. Many surgical interventions are associated with significant pain and heavy economic burden. Therefore, our aim was to evaluate the outcomes of a new nonoperative treatment for fracture nonunion. PATIENT CONCERNS A 44-year-old man suffered closed fractures of the right tibia and left femur. Eleven months after surgery, there was no radiographic healing between fracture fragments. DIAGNOSES Fracture nonunion of the right tibia and left femur. INTERVENTIONS The patient received systemic treatment with teriparatide (recombinant human Parathyroid Hormone 1-34) 20 μg/d for 8 months, with further observation at 4 months after discontinuation. During treatment, bone metabolic markers were measured to evaluate metabolic activity of osteoblasts and osteoclasts. The Ethics Committee of Qilu Hospital of Shandong University approved this study. OUTCOMES Satisfactory healing of fracture nonunion was obtained without further intervention. LESSONS Anabolic treatment with teriparatide showed a positive effect on healing of fracture nonunion. Evaluation of bone metabolic markers during treatment is necessary to observe the curative effect. In view of the positive effect of teriparatide on healing of fracture nonunion in numerous animal models and clinical studies, it may be a promising alternative treatment for fracture nonunion in patients who are not suitable for surgical intervention.
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Foulke BA, Kendal AR, Murray DW, Pandit H. Fracture healing in the elderly: A review. Maturitas 2016; 92:49-55. [PMID: 27621238 DOI: 10.1016/j.maturitas.2016.07.014] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 07/19/2016] [Accepted: 07/20/2016] [Indexed: 01/08/2023]
Abstract
Older patients are commonly at a higher risk of experiencing a bone fracture. Complications during fracture healing, including delayed union and non-union, can arise as a result of a multitude of patient and treatment factors. This review describes those factors which contribute to a greater risk of delayed union and non-union with particular reference to the elderly population and discusses therapies that may enhance the fracture healing process in the hope of reducing the incidence of delayed union and non-union. Increasing age does seem to increase the risk of delayed union or non-union. In addition, smoking and the treatment of post-fracture pain with non-steroidal anti-inflammatory drugs (NSAIDs) put the patient at the greatest risk, while ultrasound therapy appears to be a non-invasive, effective treatment option to reduce the risk of delayed union or non-union. The use of growth factors and of stem cells and the role of surgery are also discussed.
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Affiliation(s)
- Bradley A Foulke
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford University, Nuffield Orthopaedic Centre, Windmill Road, Oxford OX3 7LD, UK.
| | - Adrian R Kendal
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford University, Nuffield Orthopaedic Centre, Windmill Road, Oxford OX3 7LD, UK
| | - David W Murray
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford University, Nuffield Orthopaedic Centre, Windmill Road, Oxford OX3 7LD, UK
| | - Hemant Pandit
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford University, Nuffield Orthopaedic Centre, Windmill Road, Oxford OX3 7LD, UK
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Pountos I, Panteli M, Lampropoulos A, Jones E, Calori GM, Giannoudis PV. The role of peptides in bone healing and regeneration: a systematic review. BMC Med 2016; 14:103. [PMID: 27400961 PMCID: PMC4940902 DOI: 10.1186/s12916-016-0646-y] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Bone tissue engineering and the research surrounding peptides has expanded significantly over the last few decades. Several peptides have been shown to support and stimulate the bone healing response and have been proposed as therapeutic vehicles for clinical use. The aim of this comprehensive review is to present the clinical and experimental studies analysing the potential role of peptides for bone healing and bone regeneration. METHODS A systematic review according to PRISMA guidelines was conducted. Articles presenting peptides capable of exerting an upregulatory effect on osteoprogenitor cells and bone healing were included in the study. RESULTS Based on the available literature, a significant amount of experimental in vitro and in vivo evidence exists. Several peptides were found to upregulate the bone healing response in experimental models and could act as potential candidates for future clinical applications. However, from the available peptides that reached the level of clinical trials, the presented results are limited. CONCLUSION Further research is desirable to shed more light into the processes governing the osteoprogenitor cellular responses. With further advances in the field of biomimetic materials and scaffolds, new treatment modalities for bone repair will emerge.
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Affiliation(s)
- Ippokratis Pountos
- Department of Trauma & Orthopaedics, School of Medicine, University of Leeds, Leeds, UK
| | - Michalis Panteli
- Department of Trauma & Orthopaedics, School of Medicine, University of Leeds, Leeds, UK
| | | | - Elena Jones
- Unit of Musculoskeletal Disease, Leeds Institute of Rheumatic and Musculoskeletal Medicine, St. James University Hospital, University of Leeds, LS9 7TF, Leeds, UK
| | - Giorgio Maria Calori
- Department of Trauma & Orthopaedics, School of Medicine, ISTITUTO ORTOPEDICO GAETANO PINI, Milan, Italy
| | - Peter V Giannoudis
- Department of Trauma & Orthopaedics, School of Medicine, University of Leeds, Leeds, UK. .,NIHR Leeds Biomedical Research Unit, Chapel Allerton Hospital, LS7 4SA Leeds, West Yorkshire, Leeds, UK.
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Kastirr I, Radmer S, Andresen R, Schober HC. Osseous Consolidation of an Aseptic Delayed Union of a Lower Leg Fracture after Parathyroid Hormone Therapy - A Case Report. J Clin Diagn Res 2016; 10:RD03-5. [PMID: 27630919 DOI: 10.7860/jcdr/2016/20006.8203] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Accepted: 05/25/2016] [Indexed: 01/08/2023]
Abstract
The absence of osseous consolidation of a fracture within the normal time period is defined as delayed union or non-union. Both for the patient and from a socio-economic point of view, impaired fracture healing represents a major problem. Risk factors for a delayed fracture healing are insufficient immobilisation, poor adaptation of the fracture surfaces, interposition of soft tissue in the fracture gap, as well as circulation disturbances, metabolic disease, smoking and infections. In animal studies, a positive effect of parathyroid hormone (PTH) on fracture healing has been shown. PTH has a direct stimulatory effect on osteoblasts and osteoclasts. In addition, it appears to influence the effect of osseous growth factors. Few cases with the empiric off-label use of PTH that showed a tendency to support delayed or non-union fractures have been published. We report about a patient with a fracture of the lower leg and no osseous consolidation after 7 months. Four Months after therapy with 20 μg teriparatide per day for 8 weeks the fracture was consolidated and the patient had regained full and pain free weight bearing capacity of the leg with no reported side effects.
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Affiliation(s)
- Ilko Kastirr
- Medical Assistant, Institute of Diagnostic and Interventional Radiology/Neuroradiology , Westkuestenklinikum Heide, Germany
| | | | - Reimer Andresen
- Head of the Institute of Diagnostic and Interventional Radiology/Neuroradiology , Westkuestenklinikum Heide, Germany
| | - Hans-Christof Schober
- Head, Department of Internal Medicine I, Municipal Hospital Suedstadt Rostock , Germany
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Periprosthetic Atypical Femoral Fractures in Patients on Long-term Bisphosphonates: A Multicenter Retrospective Review. J Orthop Trauma 2016; 30:170-6. [PMID: 27003029 DOI: 10.1097/bot.0000000000000508] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To define the characteristics of periprosthetic atypical femoral fractures (PAFFs) in patients on long-term bisphosphonate treatment and to provide a guide to the diagnosis and long-term treatment of these patients based on the literature. DESIGN Multicenter retrospective review. SETTING Fifteen orthopaedic centers in the United States and Canada, including members of the Canadian Orthopaedic Trauma Society. PATIENTS/PARTICIPANTS Patients on long-term bisphosphonates who presented with either periprosthetic fractures or femoral fractures, over a 10-year period. MAIN OUTCOME MEASUREMENTS Time to union and complications. RESULTS Clinically significant differences were identified in time to union, mortality, and complications. There was a statistically significant difference in complications. Imaging review demonstrated identical features in both atypical femoral fractures (AFFs) and PAFFs. CONCLUSIONS This is the largest comparative case series reported on PAFFS and AFFs and provides compelling evidence that PAFFs in patients on long-term bisphosphonates are indeed a subset of periprosthetic fractures that exhibit atypical femoral fracture (AFF) characteristics. As such, these fractures pose serious diagnostic and management challenges to trauma and arthroplasty surgeons. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Ramani A, Wagner R. Periprosthetic Femoral Stress Fracture After Bisphosphonate Treatment Resulting in Nonunion Successfully Treated with Teriparatide: A Case Report. JBJS Case Connect 2016; 6:e37. [PMID: 29252670 DOI: 10.2106/jbjs.cc.15.00172] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
CASE We present the case of a postmenopausal osteoporotic woman, treated with bisphosphonates, who developed a stress fracture at the tip of a revision femoral component, resulting in nonunion after several operative treatment attempts. The nonunion healed after 7 months of subcutaneous injections of 20 μg/day of teriparatide. CONCLUSION Teriparatide treatment should be considered for use in recalcitrant stress fractures after total hip arthroplasty.
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Affiliation(s)
- Azaan Ramani
- University of North Texas Health Science Center, Fort Worth, Texas
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36
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Morse A, Cheng TL, Peacock L, Mikulec K, Little DG, Schindeler A. RAP-011 augments callus formation in closed fractures in rats. J Orthop Res 2016; 34:320-30. [PMID: 26185108 DOI: 10.1002/jor.22985] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 07/14/2015] [Indexed: 02/04/2023]
Abstract
ACE-011 is a bone anabolic agent generated by fusing the extracellular domain of the Activin Type 2A receptor (ActRIIA) to an IgG-Fc. The orthopedic utility of ACE-011 was investigated using a murine analogue, RAP-011. Initially, a rat closed fracture model was tested using bi-weekly (biw) 10 mg/kg RAP-011. RAP-011 significantly increased callus length and callus bone volume (BV, +43% at 6w, p < 0.01). The polar moment of inertia was calculated to be substantively increased (+80%, p < 0.01), however mechanical bending tests showed a more modest increase in maximum load to failure (+24%, p < 0.05). Histology indicated enhanced appositional bone growth, but it was hypothesized that reduced remodeling, evidenced by decreased serum CTX (-16% at 6w, p < 0.01), could be compromising bone quality in the callus. A second closed fracture study was performed to examine lower "pulse" [RAP-011(p)] and "sustained" [RAP-011(s)] regimens of biw 0.6mg/kg × 2, 0.35mg/kg × 3 and 0.18mg/kg × 2, 0.1mg/kg × 7 respectively, compared with PTH(1-34) (25 μg/kg/d) and vehicle controls. RAP-011 treatments gave modest increases in callus length and callus BV at 6w (p < 0.01), but did not achieve an increase in maximum load over vehicle. In summary, RAP-011 is effective in promoting bone formation during repair, but optimizing callus bone quality will require further investigation.
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Affiliation(s)
- Alyson Morse
- Orthopaedic Research and Biotechnology Unit, The Children's Hospital at Westmead, Sydney, Australia.,Discipline of Paediatrics and Child Health, Faculty of Medicine, University of Sydney, Sydney, Australia
| | - Tegan L Cheng
- Orthopaedic Research and Biotechnology Unit, The Children's Hospital at Westmead, Sydney, Australia.,Discipline of Paediatrics and Child Health, Faculty of Medicine, University of Sydney, Sydney, Australia
| | - Lauren Peacock
- Orthopaedic Research and Biotechnology Unit, The Children's Hospital at Westmead, Sydney, Australia
| | - Kathy Mikulec
- Orthopaedic Research and Biotechnology Unit, The Children's Hospital at Westmead, Sydney, Australia
| | - David G Little
- Orthopaedic Research and Biotechnology Unit, The Children's Hospital at Westmead, Sydney, Australia.,Discipline of Paediatrics and Child Health, Faculty of Medicine, University of Sydney, Sydney, Australia
| | - Aaron Schindeler
- Orthopaedic Research and Biotechnology Unit, The Children's Hospital at Westmead, Sydney, Australia.,Discipline of Paediatrics and Child Health, Faculty of Medicine, University of Sydney, Sydney, Australia
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Féron JM, Mauprivez R. Fracture repair: general aspects and influence of osteoporosis and anti-osteoporosis treatment. Injury 2016; 47 Suppl 1:S10-4. [PMID: 26768282 DOI: 10.1016/s0020-1383(16)30003-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Bone differs from other tissues in its capacity to self-repair after a fracture. The low bone mass and structural deterioration of bone associated with osteoporosis increases the risk of fragility fracture compared with healthy individuals. The intention of this article is to review the complex process of fracture repair and essential requirements for a successful fracture healing response summarized as the "diamond concept" in terms of aging and osteoporosis. The current preclinical and clinical evidence for a beneficial or harmful influence of anti-osteoporosis medications such as bisphosphonates, parathyroid hormone (PTH), strontium ranelate and antibodies of Wnt-inhibiting signaling proteins on bone healing is presented and discussed. Literature suggests that there are no detrimental consequences of such therapeutics on fracture repair processes. Following a fragility fracture, it seems that early start of preventive anti-osteoporotic treatment right after surgery does not delay the union of the fracture, except perhaps in the case of very rigidly fixed fracture requiring direct bone healing. There is some promising experimental and clinical evidence for possible enhancement of the bone repair process via administration of systemic agents. Further well designed studies in humans are necessary to accumulate more evidence on the positive effects and to translate this knowledge into valid therapeutic applications.
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Affiliation(s)
- Jean-Marc Féron
- Professor of Orthopaedic Surgery, Chair of the Orthopaedic and Trauma Department, Saint Antoine Hospital. UPMC-Sorbonne Universities, Paris, France.
| | - Raphaël Mauprivez
- Senior lecturer, Orthopaedic and Trauma Department, Saint Antoine Hospital. UPMC-Sorbonne Universities, Paris, France
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Calori GM, Colombo M, Bucci M, Mazza EL, Fadigati P, Mazzola S. Clinical effectiveness of Osigraft in long-bones non-unions. Injury 2015; 46 Suppl 8:S55-64. [PMID: 26747920 DOI: 10.1016/s0020-1383(15)30056-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Current evidence, based primarily on case series, suggest that the eptotermin alfa (recombinant bone morphogenetic protein-7 (rhBM-7)), which is commercialized as Osigraft with an indication for tibial non-union, used in monotherapy or polytherapy, is a safe and effective therapy for long bones non-unions of lower and upper limbs. No previous study has compared the safety and the efficacy of Osigraft and the "gold standard" treatment for recalcitrant long-bones non-union, autologous bone graft (ABG). This study aims to compare the effectiveness of Osigraft and ABG in the treatment of post-traumatic, persistent long bone non-unions. In particular, the present study will focus exclusively on complex persistent non-unions, excluding simpler cases, in which it is likely that a simple revision of the osteosynthesis will be sufficient to promote union, and extremely severe cases in which there is an indication for amputation and prosthesis. The study addresses the following research question: 1. Is the effectiveness of eptotermin alfa comparable to that of ABG in the treatment of complex long bone non-unions? 2. Are there significant differences in the prevalence of adverse events between patients treated with eptotermin alfa and those treated with ABG? The study is an observational, retrospective study, located in one Experimental Recruiting Center (Ospedale Universitario G. PINI - Milano). The study was conducted with ethics approval and according with the existing Italian law. Demographic and clinical data were collected from patients Clinical Medical Records and other existing documentation, through a web based eCRF. The treatment (surgery with Osigraft or ABG) effectiveness was evaluated comparing the number of success cases (primary endpoint) and the length for clinical and radiological healing (secondary end-points). The treatment safety was evaluating comparing the prevalence of Adverse Events. Osigraft was demonstrated to be statistically equivalent to ABG with respect to the primary and secondary end point of surgical success. The treatment success was statistically comparable across all the anatomical regions considered, both in patients treated with Osigraft and in patients treated with ABG. The use of Osigraft when compared to autograft was associated with statistically lower intraoperative blood loss and shorter operative times. In addition patients treated with Osigraft developed statistically less peri-operative and late onset adverse events, compared to ABG. The difference was substantially due to the occurrence of pain at donor site in patients treated with ABG.
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Affiliation(s)
- Giorgio Maria Calori
- C.O.R., Reparative Orthopaedic Surgery Department - Orthopaedic Institute G. Pini, University of Milan, Italy.
| | - Massimiliano Colombo
- C.O.R., Reparative Orthopaedic Surgery Department - Orthopaedic Institute G. Pini, University of Milan, Italy
| | - Miguel Bucci
- C.O.R., Reparative Orthopaedic Surgery Department - Orthopaedic Institute G. Pini, University of Milan, Italy
| | - Emilio Luigi Mazza
- C.O.R., Reparative Orthopaedic Surgery Department - Orthopaedic Institute G. Pini, University of Milan, Italy
| | - Piero Fadigati
- C.O.R., Reparative Orthopaedic Surgery Department - Orthopaedic Institute G. Pini, University of Milan, Italy
| | - Simone Mazzola
- C.O.R., Reparative Orthopaedic Surgery Department - Orthopaedic Institute G. Pini, University of Milan, Italy
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Im GI, Lee SH. Effect of Teriparatide on Healing of Atypical Femoral Fractures: A Systemic Review. J Bone Metab 2015; 22:183-9. [PMID: 26713309 PMCID: PMC4691592 DOI: 10.11005/jbm.2015.22.4.183] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 11/30/2015] [Accepted: 11/30/2015] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Bisphosphonates (BPs) are the most commonly used anti-osteoporotic drugs, which have been proven to reduce the risk of osteoporotic fractures. However, use of BPs, particularly for long periods of time, is associated with an increased risk of atypical femoral fracture (AFF). Healing of BP-associated AFF is usually delayed because of suppressed bone turnover. Teriparatide (TPTD), a recombinant form of parathyroid hormone (PTH), enhances bone healing in patients with delayed healing or non-union. METHODS In this study, we summarized and performed a systemic review of the published literature on treatment of AFF using TPTD. RESULTS Although there is a lack of level 1 studies on the evidence of TPTD in promoting bone union in AFFs, this systemic review of the available literature revealed that TPTD works positively in AFFs, and we put together the evidence that TPTD is a viable treatment option for enhancing fracture healing in AFFs. CONCLUSIONS While anecdotal evidence of beneficial effects of TPTD on fracture healing offer limited guidance for clinical decision making, a better understanding of the role of TPTD in fracture healing may be elucidated with future prospective trials.
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Affiliation(s)
- Gun-Il Im
- Department of Orthopaedics, Dongguk University Ilsan Hospital, Goyang, Korea
| | - Seong-Hyun Lee
- Department of Orthopaedics, Dongguk University Ilsan Hospital, Goyang, Korea
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40
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Successful treatment of infected femoral shaft nonunion with teriparatide after eradication of infection. CURRENT ORTHOPAEDIC PRACTICE 2015. [DOI: 10.1097/bco.0000000000000278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Miyakoshi N, Aizawa T, Sasaki S, Ando S, Maekawa S, Aonuma H, Tsuchie H, Sasaki H, Kasukawa Y, Shimada Y. Healing of bisphosphonate-associated atypical femoral fractures in patients with osteoporosis: a comparison between treatment with and without teriparatide. J Bone Miner Metab 2015; 33:553-9. [PMID: 25227287 DOI: 10.1007/s00774-014-0617-3] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2014] [Accepted: 07/07/2014] [Indexed: 11/30/2022]
Abstract
Atypical femoral fracture (AFF) often appears with bisphosphonate use. Teriparatide (TPTD) treatment may promote AFF healing, but few controlled or comparative studies have examined the effects of TPTD on healing of bisphosphonate-associated AFF. We retrospectively reviewed the medical records of 45 consecutive AFFs in 34 Japanese patients who had received oral bisphosphonates (alendronate or risedronate) for osteoporosis before AFF and had been followed for ≥12 months (range, 12-90 months). Thirty-seven complete or incomplete AFFs (82 %) were treated surgically and eight incomplete AFFs (18 %) were treated conservatively. Bisphosphonates were stopped at diagnosis. Based on TPTD use after fracture, AFFs were divided into non-TPTD (n = 24) and TPTD (n = 21) groups. Time to fracture-healing and frequency of delayed healing or non-union were compared between groups. Because fracture type (complete or incomplete) differed significantly between groups, only subanalyses for all surgically treated AFFs (complete and incomplete), surgically treated complete AFFs, and conservatively treated incomplete AFFs were performed. In subanalyses for all AFFs treated surgically, mean (± standard deviation) time to fracture healing was significantly better in the TPTD group (5.4 ± 1.5 months) than in the non-TPTD group (8.6 ± 4.7 months; P = 0.012), and the frequency of delayed healing or non-union was significantly lower in the TPTD group than in the non-TPTD group (P = 0.014). Subanalyses for surgically treated complete AFFs yielded similar results, but subanalyses for incomplete AFFs treated conservatively showed no significant differences between groups. TPTD treatment appears to significantly shorten the postoperative time to fracture healing and reduce rates of delayed healing or non-union after bisphosphonate-associated AFF.
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Affiliation(s)
- Naohisa Miyakoshi
- Department of Orthopedic Surgery, Akita University School of Medicine, 1-1-1 Hondo, Akita, 010-8543, Japan,
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Uemura T, Okada M, Yokoi T, Shintani K, Nakamura H. Successful Bone Healing of Nonunion After Ulnar Shortening Osteotomy for Smokers Treated With Teriparatide. Orthopedics 2015; 38:e733-7. [PMID: 26270762 DOI: 10.3928/01477447-20150804-90] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 01/16/2015] [Indexed: 02/03/2023]
Abstract
Ulnar shortening osteotomy is widely performed as the standard surgical treatment for ulnar impaction syndrome and has a high percentage of success for pain relief. However, delayed union and nonunion of the osteotomy site remain the most concerning complications. In particular, smokers have a higher incidence of nonunion, which amounts to 30% of cases. For the treatment of nonunion, secondary surgical interventions such as bone grafting will be necessary but are extremely challenging. Recently, teriparatide (recombinant human parathyroid hormone [PTH 1-34]) administration has been reported in several clinical studies as a noninvasive pharmacological systemic treatment for fracture healing or nonunion. The authors present 2 cases of smokers, a 62-year-old man and a 42-year-old woman, with nonunion after ulnar shortening osteotomy and fixation with 6-hole non-locking plate for ulnar impaction syndrome. For treatment of nonunion, noninvasive therapy with teriparatide (20-µg, subcutaneous injection) in addition to low-intensity pulsed ultrasound was underwent. In both cases, partial bone union began to be observed on radiographs after the first 4 weeks of teriparatide administration and successful bone healing without additional surgical interventions was achieved after 10 and 6 months of treatment with teriparatide, respectively. The current case reports showed that non-invasive combination therapy of teriparatide and low-intensity pulsed ultrasound were a possible alternative to surgical intervention. In the future, teriparatide therapy might be applied actively to patients who have risk factors for delayed union, such a heavy smoking habit, and are expected to experience nonunion after ulnar shortening osteotomy.
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Nonsurgical Corrective Union of Osteoporotic Vertebral Fracture with Once-Weekly Teriparatide. Case Rep Orthop 2015; 2015:784360. [PMID: 26294995 PMCID: PMC4534610 DOI: 10.1155/2015/784360] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2015] [Accepted: 07/26/2015] [Indexed: 12/15/2022] Open
Abstract
Osteoporotic vertebral fractures usually heal with kyphotic deformities with subsidence of the vertebral body when treated conservatively. Corrective vertebral union using only antiosteoporotic pharmacotherapy without surgical intervention has not been reported previously. An 81-year-old female with osteoporosis presented with symptomatic fresh L1 vertebral fracture with intravertebral cleft. Segmental vertebral kyphosis angle (VKA) at L1 was 20° at diagnosis. Once-weekly teriparatide administration, hospitalized rest, and application of a thoracolumbosacral orthosis alleviated symptoms within 2 months. Corrective union of the affected vertebra was obtained with these treatments. VKA at 2 months after injury was 8° (correction, 12°) and was maintained as of the latest follow-up at 7 months. Teriparatide has potent bone-forming effects and has thus been expected to enhance fracture healing. Based on the clinical experience of this case, teriparatide may have the potential to allow correction of unstable vertebral fractures without surgical intervention.
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44
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Sabharwal S, Louie KW, Reid JS. What's new in limb-lengthening and deformity correction. J Bone Joint Surg Am 2014; 96:1399-406. [PMID: 25143503 DOI: 10.2106/jbjs.n.00369] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Sanjeev Sabharwal
- Department of Orthopedics, Rutgers-New Jersey Medical School, 90 Bergen Street, Doctor's Office Center, Suite 7300, Newark, NJ 07103. E-mail address for S. Sabharwal:
| | - Kevin W Louie
- Department of Orthopedics, Rutgers-New Jersey Medical School, 90 Bergen Street, Doctor's Office Center, Suite 7300, Newark, NJ 07103. E-mail address for S. Sabharwal:
| | - J Spence Reid
- Department of Orthopedics, Rutgers-New Jersey Medical School, 90 Bergen Street, Doctor's Office Center, Suite 7300, Newark, NJ 07103. E-mail address for S. Sabharwal:
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45
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Tachiiri H, Okuda Y, Yamasaki T, Kusakabe T. Weekly teriparatide administration for the treatment of delayed union: a report of two cases. Arch Osteoporos 2014; 9:179. [PMID: 24777526 DOI: 10.1007/s11657-014-0179-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Accepted: 04/10/2014] [Indexed: 02/03/2023]
Abstract
UNLABELLED Two cases of delayed union that were effectively treated with weekly TPTD administration are described. The effect of this therapy was observed within 4 weeks. INTRODUCTION In the first case, a 72-year-old woman underwent osteotomy for the treatment of hallux valgus. Bone union was still not observed 4 months after surgery. Therefore, weekly teriparatide (56.5 mg) injections were administered, resulting in the initiation of bone union within 4 weeks and complete bone union 4 months after the first teriparatide injection. In the second case, a 72-year-old woman underwent open reduction and internal fixation of an olecranon fracture. Bone union was delayed 4 months after surgery; therefore, weekly teriparatide (56.5 mg) injections were started. RESULTS The initiation of bone union was slightly evident within 4 weeks, and complete healing was achieved 4 months after the first teriparatide injection. In both cases, no serious teriparatide-related adverse effects were observed. CONCLUSION Weekly teriparatide administration was effective for bone healing and useful for delayed union; moreover, the effect of this therapy showed within 4 weeks.
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Affiliation(s)
- Hisakazu Tachiiri
- Department of Orthopedic Surgery, Japanese Red Cross Kyoto Daini Hospital, 355-5 Haruobi-cho, Kamanza, Marutamachi, Kamigyo-ku, Kyoto, 602-8026, Japan,
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Giannotti S, Bottai V, Dell'Osso G, De Paola G, Ghilardi M, Guido G. Pseudoarthrosis in atypical femoral fracture: case report. Osteoporos Int 2013; 24:2893-5. [PMID: 23681089 DOI: 10.1007/s00198-013-2397-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Accepted: 03/26/2013] [Indexed: 10/26/2022]
Abstract
Atypical femoral fractures can be subsequent to a long-term biphosphonates treatment; they have a high frequency of delayed healing. The authors describe a femoral pseudoarthrosis of an atypical fracture treated with intramedullary nailing in a female after prolonged alendronate therapy. Atypical femoral fractures can be subsequent to a long-term biphosphonates treatment even if, in the literature, there is no clarity on the exact pathogenetic mechanism. The Task Force of the American Society for Bone and Mineral Research described the major and minor features to define atypical fractures and recommends that all the five major features must be present while minor features are not necessary. Another controversial aspect regarding the atypical femoral fractures is the higher frequency of the delayed healing that can be probably related to a suppressed bone turnover caused by a prolonged period of bisphosphonates treatment. This concept could be corroborated by the Spet Tc exam. In the case of a pseudoarthrosis, there is not a standardization of the treatment. In this report, the authors describe a femoral pseudoarthrosis of an atypical fracture treated with intramedullary nailing in a female after prolonged alendronate therapy; the patient was studied with clinical, bioumoral end SPECT-Tc exam of both femurs. Many studies show the relationship between bisphosphonates and the presence of atypical fractures. These fractures should be monitored more closely due to the risk of nonunion and they require considering an initial treatment with pharmacological augmentation to reduce the complications for the patient and the health care costs.
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Affiliation(s)
- S Giannotti
- Clinica Ortopedica e Traumatologica II, Universita' Di Pisa, Via Paradisa 2, Pisa, Italy,
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Nardi A, Ventura L, Cozzi L, Tonini G, Zennaro R, Celi M, Ramazzina E. The bone anabolic therapy. Aging Clin Exp Res 2013; 25 Suppl 1:S121-4. [PMID: 24078441 DOI: 10.1007/s40520-013-0133-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Accepted: 08/23/2013] [Indexed: 11/30/2022]
Abstract
Teriparatide (TPTD), the amino-terminal parathyroid hormone recombinant peptide [PTH (1–34)], is a drug with a proven anabolic action on the bone, effective in preventing vertebral and non-vertebral fragility fractures. Recent publications have investigated in great detail the TPTD action on the cortical bone, highlighting the increased strength in the critical zone of the hip with high risk of fracture in osteoporotic patients Poole (PLoS ONE 6:e16190, 2011). In November 2002, TPTD was approved by the FDA for use in post-menopausal women and men with osteoporosis at high risk of fracture and in patients with glucocorticoid-induced osteoporosis and, since then, has been used to treat more than 1 million patients worldwide (J Bone Miner Res 27(12):2429-2437, 2012). The unchanged safety profile and the well-known mechanism of action of this drug have led doctors to explore the use of TPTD in other conditions such as delayed fracture healing, non-union, osteonecrosis of the jaw, etc. The positive reports that have resulted from these studies are helping to hypothesize a new perspective on the wider use of this drug, but warrant further clinical investigation to consolidate these results.
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Steinhausen E, Glombitza M, Böhm HJ, Hax PM, Rixen D. Pseudarthrosen. Unfallchirurg 2013; 116:633-47; quiz 648-9. [DOI: 10.1007/s00113-013-2413-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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