Kim Sang-Min, Kang Kyung-Chung, Kim Ji Wan, Lim Seung-Jae, Hahn Myung Hoon
Department of Orthopaedic Surgery, Seoul Medical Center, Seoul, Korea.
Department of Orthopaedic Surgery, Kyung Hee University Hospital, Kyung Hee University, Seoul, Korea.
J Bone Metab. 2017 Feb;24(1):65-73. doi: 10.11005/jbm.2017.24.1.65. Epub 2017 Feb 28.
The use of osteoanabolic agents to facilitate fracture healing has been of heightened interest to the field of orthopaedic trauma. This study aimed to evaluate the evidence of teriparatide for fracture healing and functional recovery in osteoporotic patients.
We performed a literature search in PubMed, EMBASE, Web of Science, and the Cochrane Library using terms including "Fracture" [tiab] AND "Teriparatide [tiab] OR "PTH" [tiab].
This systematic review included 6 randomized clinical trials, 4 well-controlled retrospective studies, and 1 retrospective post hoc subgroup analysis. Fracture location was 2 in pelvis, 3 in proximal femur, 1 in distal femur, 1 in shoulder, 2 in wrist and 2 in spine. The use of teriparatide yielded positive effects on radiographic bone healing in 6 studies, but was not associated with better radiographic outcome in 3. In terms of functional recovery, teriparatide injection was related with decrease in pain or shorter time to mobilization in 6 studies, but not related with pain numerical scale and mobility in 3.
Our findings suggest that teriparatide provide selective advantages to fracture healing or functional recovery in the management of osteoporotic fractures. A better understanding of the role of teriparatide on osteoporotic fractures requires greater evidences from large volume prospective trials.
使用骨合成代谢药物促进骨折愈合一直是创伤骨科领域备受关注的问题。本研究旨在评估特立帕肽在骨质疏松患者骨折愈合和功能恢复方面的证据。
我们在PubMed、EMBASE、Web of Science和Cochrane图书馆进行了文献检索，检索词包括“骨折”[标题/摘要] AND “特立帕肽”[标题/摘要] OR “甲状旁腺激素”[标题/摘要]。
本系统评价纳入了6项随机临床试验、4项对照良好的回顾性研究和1项回顾性事后亚组分析。骨折部位为骨盆2例、股骨近端3例、股骨远端1例、肩部1例、腕部2例和脊柱2例。6项研究表明使用特立帕肽对影像学骨愈合有积极作用，但3项研究未发现其与更好的影像学结果相关。在功能恢复方面，6项研究表明注射特立帕肽与疼痛减轻或活动时间缩短有关，但3项研究未发现其与疼痛数字评分和活动能力有关。
我们的研究结果表明，在骨质疏松性骨折的治疗中，特立帕肽对骨折愈合或功能恢复具有选择性优势。需要更多来自大量前瞻性试验的证据，才能更好地了解特立帕肽在骨质疏松性骨折中的作用。
