Huang Tsan-Wen, Chuang Po-Yao, Lin Shih-Jie, Lee Chien-Yin, Huang Kuo-Chin, Shih Hsin-Nung, Lee Mel S, Hsu Robert Wen-Wei, Shen Wun-Jer
From the Department of Orthopedic Surgery (T-WH, P-YC, S-JL, C-YL, K-CH, RW-WH) and Sports Medicine Center (RW-WH), Chang Gung Memorial Hospital, Chiayi, Taiwan; Department of Orthopedic Surgery, Kaohsiung Chang Gung Memorial Hospital, Taiwan (MSL); Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan (H-NS); Chang Gung University, Taoyuan, Taiwan (T-WH, K-CH, H-NS, MSL, RW-WH); and Po-Cheng Orthopedic Institute, Kaohsiung (W-JS), Taiwan.
Medicine (Baltimore). 2016 May;95(19):e3626. doi: 10.1097/MD.0000000000003626.
Osteoporotic intertrochanteric fractures result in serious health problems and decrease health-related quality of life (HRQoL). Faster time-to-union is important for early return to daily activities and reduction of complications. Teriparatide has been shown to accelerate fracture healing, but the literature is sparse on this topic. The aim of this study is to assess whether teriparatide accelerates fracture healing.Between 2008 and 2014, patients with osteoporotic intertrochanteric fractures who underwent surgical interventions were enrolled in this retrospective cohort study. Group 1 included patients who were not on any osteoporosis medication prior to fracture and who postoperatively received only calcium and vitamin D; patients in Group 2 were not on any osteoporosis medication prior to fracture, and received teriparatide and calcium and vitamin D postoperatively. Patients in Group 3 were those who were on alendronate prior to fracture and postfracture received teriparatide as well as calcium and vitamin D. Demographics, time-to-union, HRQoL (short-form health survey [SF]-12 physical component summary [PCS] and SF-12 mental component summary [MCS]), morbidities, mortalities, and radiographic and functional outcomes between groups were compared.A total of 189 patients were enrolled in this study. There were 83 patients in Group 1, 47 patients in Group 2, and 59 patients in Group 3. A significantly shorter time-to-union was found in the teriparatide-treated groups (mean, 13.6, 12.3, and 10.6 weeks, respectively [P = 0.002]). With regard to SF-12 PCS, the scores were significantly better in teriparatide-treated groups at 3 months (mean, 19, 28, and 29, respectively [P = 0.002]) and 6 months (mean, 28, 37, and 38, respectively [P = 0.008]). Similar inter-group differences were noted when comparing the pain scores, the ability to get around the house, the ability to get out of the house, and the ability to go shopping at 3 and 6 months. Complications and mortality were also markedly reduced in the teriparatide-treated groups.Postoperative use of teriparatide for 6 months appears to be an effective adjunct therapy in the treatment of patients with osteoporotic intertrochanteric fractures. However, because of the limited power of the study, a prospective, randomized, large-scale cohort study is still required for determining the efficacy of teriparatide.
骨质疏松性粗隆间骨折会导致严重的健康问题，并降低与健康相关的生活质量（HRQoL）。更快的骨折愈合时间对于早日恢复日常活动和减少并发症至关重要。特立帕肽已被证明可加速骨折愈合，但关于这一主题的文献较少。本研究的目的是评估特立帕肽是否能加速骨折愈合。
在2008年至2014年期间，对接受手术干预的骨质疏松性粗隆间骨折患者进行了这项回顾性队列研究。第1组包括骨折前未服用任何骨质疏松药物且术后仅接受钙和维生素D的患者；第2组患者骨折前未服用任何骨质疏松药物，术后接受特立帕肽以及钙和维生素D。第3组患者是骨折前服用阿仑膦酸钠且骨折后接受特立帕肽以及钙和维生素D的患者。比较了各组之间的人口统计学、骨折愈合时间、HRQoL（简短健康调查问卷[SF]-12身体成分总结[PCS]和SF-12心理成分总结[MCS]）、发病率、死亡率以及影像学和功能结果。
本研究共纳入189例患者。第1组有83例患者，第2组有47例患者，第3组有59例患者。在接受特立帕肽治疗的组中发现骨折愈合时间明显更短（平均分别为13.6周、12.3周和10.6周[P = 0.002]）。关于SF-12 PCS，在3个月时（平均分别为19、28和29[P = 0.002]）和6个月时（平均分别为28、37和38[P = 0.008]），接受特立帕肽治疗的组得分明显更好。在比较3个月和6个月时的疼痛评分、在家中活动的能力、外出的能力以及购物的能力时，也发现了类似的组间差异。接受特立帕肽治疗的组并发症和死亡率也明显降低。
术后使用特立帕肽6个月似乎是治疗骨质疏松性粗隆间骨折患者的一种有效辅助疗法。然而，由于本研究的样本量有限，仍需要进行一项前瞻性、随机、大规模队列研究来确定特立帕肽的疗效。
