EVALUATING THE ROLE OF LOW-DOSE TERIPARATIDE IN INTERTROCHANTERIC FRACTURE FOLLOWING SURGICAL MANAGEMENT: A PROSPECTIVE STUDY

Abstract

Background:
The most frequently encountered fractures in elderly is Intertrochanteric fractures which are associated with significant morbidity and mortality. Stable & unstable fractures can be managed with dynamic hip screw (DHS) fixation & proximal femoral nail (PFN). Despite surgical advancements, complications such as delayed union, non-union, implant failure, and suboptimal functional recovery remain concerns, especially in osteoporotic bone. Teriparatide, a recombinant human parathyroid hormone (PTH 1–34), has demonstrated potential in enhancing bone formation. This study is performed to evaluate the efficacy of low-dose teriparatide in enhancing fracture union, reducing complications, and improving functional outcomes in elderly patients with osteoporotic intertrochanteric fractures managed surgically.

Methods:
This prospective observational study was conducted at Saveetha Medical College and Hospital from January 2023 to January 2025. Fifty patients aged ≥50 years with osteoporotic intertrochanteric fractures treated with dynamic hip screw (DHS) or proximal femoral nail (PFN) were included. Patients were randomized into two groups: Group A (n=25) received low-dose teriparatide (20 µg subcutaneously on alternate days for 3 months) along with standard care, and Group B (n=25) received standard postoperative care alone. Patients were followed at 6, 12, and 24 weeks. Primary outcome was time to radiological union; secondary outcomes included Harris Hip Score (HHS), Visual Analog Scale (VAS) for pain, and complication rates.

Results:
Group A showed significantly faster fracture union (11.2 ± 1.5 weeks) compared to Group B (13.6 ± 2.1 weeks, p < 0.001). At 12 weeks, union was achieved in 84% of patients in Group A versus 60% in Group B (p = 0.041). HHS was significantly higher in Group A at both 12 and 24 weeks, while VAS pain scores were lower at 6 and 12 weeks. Group A also had fewer complications, with only one case of delayed union and no implant-related failures or reoperations, whereas Group B had four delayed unions, one implant cut-out, and one reoperation.

Conclusion:
Low-dose teriparatide administered postoperatively for three months significantly enhances early fracture healing, reduces pain, and improves functional recovery in surgically managed osteoporotic intertrochanteric fractures. It represents a clinically beneficial and cost-effective adjunct in the postoperative management of elderly patients.