ROLE OF SUPPLEMENTAL TERIPARATIDE THERAPY TO AUGMENT FRACTURE HEALING IN INTERTROCHANTERIC FRACTURES OF THE HIP IN ELDERLY PATIENTS

Abstract

Background: Osteoporotic intertrochanteric femur fractures remain a significant challenge for orthopedic surgeons, despite advancements in surgical techniques. The compromised bone quality inherent to osteoporosis often makes achieving stable fixation and favorable outcomes difficult. Consequently, contemporary research has shifted towards a more holistic management strategy—integrating surgical intervention with targeted treatment of the underlying osteoporosis. This comprehensive approach aims to improve long-term outcomes, reduce complication rates, and enhance quality of life in this vulnerable patient population. Teriparatide, a recombinant form of human parathyroid hormone, is increasingly recognized as a potential therapeutic agent for enhancing fracture healing, with supportive evidence from both animal models and clinical studies. The present study investigates the role of teriparatide therapy in promoting fracture healing in patients with osteoporotic intertrochanteric femur fractures treated surgically. By evaluating its effects on both bone union and functional recovery, this work aims to provide evidence that could inform future research and support the development of improved treatment strategies for these challenging injuries.

Methods: In this study, osteoporotic patients who underwent surgical fixation for intertrochanteric femur fractures were monitored postoperatively. Participants were divided into two groups: one received adjunctive teriparatide therapy, while the other was provided with supplemental calcium and vitamin D. The objective was to evaluate the influence of teriparatide on fracture union time, bone mineral density (BMD), and the incidence of postoperative fracture-related complications. Functional outcomes were measured using the Harris Hip Score.

Results:A higher proportion of female patients was noted in the study cohort. All 30 participants achieved fracture union within 24 weeks. At the 6-week follow-up, no evidence of union was detected in either group. By 12 weeks, the control group (Group A) demonstrated a union rate of 13.33% (two patients), whereas the teriparatide group (Group B) achieved a union rate of 56.25% (nine patients). This difference was statistically significant (p=0.01), indicating that teriparatide may substantially accelerate fracture healing in osteoporotic intertrochanteric femur fractures. A decrease in tip–apex distance (TAD) reflected progressive migration of the helical blade as weight-bearing commenced. For the first 12 weeks, TAD values were comparable between groups. By 24 weeks, however, the mean TAD in Group A was 22.57 ± 1.33 mm, significantly lower than the 24.26 ± 1.92 mm observed in Group B (p=0.031). These findings suggest that earlier bone union and consolidation in the teriparatide group helped limit blade migration, thereby reducing the likelihood of screw cutout, hip pain, and implant failure.

Conclusions: In conclusion, the findings of this study indicate that teriparatide enhances fracture healing and promotes improvement in bone mineral density in patients with osteoporotic intertrochanteric hip fractures. Although its use is associated with higher treatment costs, the added benefits—such as earlier fracture union, notable gains in bone density and mass, and superior functional recovery—justify the investment. These results position teriparatide as a valuable adjunct in the management of osteoporotic hip fractures, with the potential to deliver better long-term patient outcomes.