Effect of teriparatide in fracture healing of intertrochanteric fracture: a prospective study

Sanjeev K. Singhal, Naresh Aggarwal, Ajay Sharma


Background: Intertrochanteric fracture is a relatively common and serious medical issue in geriatric trauma result in serious health problems and decrease health related quality of life. Faster time-to-union is important for early return to daily activities and reduction of complications. Teriparatide has been shown to accelerate fracture-healing. The purpose of the present prospective, randomized, controlled study was to evaluate the effect of teriparatide on the course of intertrochanteric fracture-healing.

Methods: Forty patients of intertrochanteric fractures who underwent surgical intervention between June 2016 and May 2017 were enrolled in this prospective study and followed for minimum of six months. Group A included patients who received only calcium supplementation; patients in Group B received teriparatide along with calcium supplementation postoperatively.

Results: The mean time to fracture healing was between 8-12 weeks for the treatment group, compared with 12-16 weeks for the control group. There was also significant effectiveness with regards to Parker and Palmer mobility score at 6 months.

Conclusions: Postoperative use of teriparatide for 6 months appears to be an effective adjunct therapy in the treatment of patients with intertrochanteric fractures. However, because of the limited power of the study a large-scale cohort study is still required for determining the efficacy of teriparatide.


Teriparatide, Fracture healing, Intertrochanteric fracture

Full Text:



Brauer CA, Coca-Perraillon M, Cutler DM. Incidence and mortality of hip fractures in the United States. JAMA. 2009;302:1573–9.

Shen SH, Huang KC, Tsai YH. Risk analysis for second hip fracture in patients after hip fracture surgery: a nationwide population-based study. J Am Med Dir Assoc. 2014;15:725–31.

Chen IJ, Chiang CY, Li YH. Nationwide cohort study of hip fractures: time trends in the incidence rates and projections up to 2035. Osteoporos Int. 2015;26:681–8.

Frost SA, Nguyen ND, CenterJR, Eisman JA, and Nguyen TV. Excess mortality attributable to hip-fracture: a relative survival analysis. Bone. 2013;56(1):23-9.

Wang CB, Lin CFJ, Liang WM. Excess mortality after hip fracture among the elderly in Taiwan: a nationwide population-based cohort study. Bone. 2013;56(1):147-53.

Gehrig LMB, Lane JM, O'Connor MI. Osteoporosis: management and treatment strategies for orthopaedic surgeons. Instruct Course Lect. 2009;58:817-32.

Schmidt AH, Braman JP, Duwelius PJ, McKee MD. Geriatric trauma: the role of immediate arthroplasty. J Bone Joint Surg Am. 2013;95(24):2030-9.

Chiu MH, Hwang HF, Lee HD. Effect of fracture type on health-related quality of life among older women in Taiwan. Arch Phys Med Rehabil. 2012;93:512–9.

Vergara I, Vrotsou K, Orive M. Factors related to functional prognosis in elderly patients after accidental hip fractures: a prospective cohort study. BMC Geriatr. 2014;14:124–32.

Orive M, Aguirre U, García-Gutiérrez S. Changes in health-related quality of life and activities of daily living after hip fracture because of a fall in elderly patients: a prospective cohort study. Int J Clin Pract. 2015;69:491–500.

Koval KJ, Cantu RV. Intertrochanteric fractures. In: Bucholz RW, Heckman JD, Court-Brown CM, editors. Rockwood and Green's fractures in adults. 6th Ed. Vol. 2. Philadelphia: Lippincott Williams and Wilkins. 2006:1793–825.

Lee PC, Hsieh PH, Chou YC, Wu CC, and Chen WJ. Dynamic hip screws for unstable intertrochanteric fractures in elderly patients—encouraging results with a cement augmentation technique. J Trauma-Inj Infec Crit Care. 2010;68(4):954-64.

Gardner MJ, Lorich DG, Lane JM. Osteoporotic femoral neck fractures: management and current controversies. Instructional Course Lectures. 2004;53:427-39.

Lorich DG, Geller DS, Nielson JH. Osteoporotic pertrochanteric hip fractures: management and current controversies. Instructional Course Lectures. 2004;53:441-54.

Eriksen EF, Keaveny TM, Gallagher ER. Literature review: the effects of teriparatide therapy at the hip in patients with osteoporosis. Bone. 2014;67:246–56.

Zhang D, Potty A, Vyas P. The role of recombinant PTH in human fracture healing: a systematic review. J Orthop Trauma. 2014;28:57–62.

Kleerekoper M, Greenspan SL, Lewiecki EM. Assessing the effects of teriparatide treatment on bone mineral density, bone microarchitecture, and bone strength. J Bone Joint Surg Am. 2014;96(11):90.

Mancilla EE, Brodsky JL, Mehta S. Teriparatide as a systemic treatment for lower extremity nonunion fractures: a case series. Endocr Pract. 2015;21:136–42.

Borges JL, Freitas A, Bilezikian JP. Accelerated fracture healing with teriparatide. Arq Bras Endocrinol Metabol. 2013;57:153–6.

Aspenberg P, Genant HK, Johansson T. Teriparatide for acceleration of fracture repair in humans: a prospective, randomized, double-blind study of 102 postmenopausal women with distal radial fractures. J Bone Miner Res. 2010;25:404–14.

Bashutski JD, Eber RM, Kinney JS. Teriparatide and osseous regeneration in the oral cavity. N Engl J Med. 2010;363:2396–405.

La Valle. Fractures of Hip. In Campbellis Operative Orthopaedics. 10th Edition (by Canale ST). Mosby publication. 2003;3:2873-938.

Singh CAK, Thong G, Laloo N: Management of Trochanteric Fractures. Indian J Orthop. 2006;40(2):100-2.

Evans EM. Trochanteric Fractures: A Review of 110 Cases treated by Nail- Plate Fixation. J Bone Joint Surg Br. 1951;33:192-204.

Oi Brien RM, Shy JC, Bublis NJ: Internal Fixation of Trochanteric Fractures of the Femur: Report of 103 Consecutive Cases. J Bone Joint Surg Am. 1946;28:791-7.

Yu CT, Wu JK, Chang CC, Chen CL, Wei JC. Early callus formation in human hip fracture treated with internal fixation and teriparatide. J Rheumatol. 2008;35:2082-3.

Gardenbroek Tjibbe. J, Segers Michiel JM, Simmermacher RKJ, Hammacher ER. The Proximal Femur Nail Antirotation: An Identifiable Improvement in the Treatment of Unstable Pertrochanteric Fractures. J Trauma. 2011;71:169-74.

Simmermacher RKJ, Ljungqvistb J, Bail CH et al. The new proximal femoral nail antirotation (PFNAW) in daily practice: Result of a multicentre clinical study. Injury, Int. J. Care Injured. 2008;39:932-9.

Huang TW, Yang TY, Huang KC, Peng KT, Lee MS et al. Effect of Teriparatide on Unstable Pertrochanteric Fractures. BioMed Res Int. 2015;2015:8.

Lou S, Houchen LV, Wang G, Zhang L et al. The Effect of Teriparatide on Fracture Healing of Osteoporotic Patients: A Meta-Analysis of Randomized Controlled Trials. BioMed Res Int. 2016;2016:1-10.