Norwich Medical School, University of East Anglia, Norwich, UK.
Norfolk and Norwich University Hospital, Norwich, UK.
Osteoporos Int. 2021 Aug;32(8):1531-1546. doi: 10.1007/s00198-021-05847-0. Epub 2021 Feb 9.
This meta-analysis evaluated the evidence for the use of parathyroid hormone (PTH) analogues to improve fracture healing. Eligible studies were prospective randomised controlled trials of adults with acute fractures treated with a PTH analogue. PTH improved functional outcomes but did not affect fracture healing rate or reduce pain.
This meta-analysis evaluated the evidence of parathyroid hormone (PTH) analogues in fracture healing. The use of PTH analogues to prevent osteoporotic fractures is well investigated, and studies are emerging on extended indications. One such indication receiving increasing attention is the effect of PTH in fracture healing; however, the overall degree of efficacy remains inconclusive.
A systematic electronic database search of MEDLINE, EMBASE and the Cochrane Library was conducted for relevant articles in August 2019 with no date restrictions. Randomised controlled trials of adults with acute fractures treated with a PTH analogue were included. PTH was compared with a comparator intervention, placebo or no treatment.
PTH analogue treatment improved functional outcomes in a range of fracture types but did not affect the fracture healing rate or reduce pain. Most trials included in this review were in elderly patients with osteoporosis. There was no evidence that PTH treatment caused harm or impeded fracture healing.
Meta-analysis of published data supports the use of PTH analogues to improve functional outcomes but not fracture healing rate or pain for different fracture types. The evidence for PTH analogue use in fracture healing is less clear in younger, non-osteoporotic patient populations. Trial design was heterogeneous and of limited quality, justifying further original trials.
本荟萃分析评估了甲状旁腺激素（PTH）类似物在骨折愈合中的证据。PTH 类似物预防骨质疏松性骨折的应用已得到充分研究，并且关于扩展适应证的研究也在不断涌现。其中一个越来越受到关注的适应证是 PTH 在骨折愈合中的作用；然而，其总体疗效仍不确定。
我们于 2019 年 8 月对 MEDLINE、EMBASE 和 Cochrane 图书馆进行了系统的电子数据库检索，检索时间无限制，纳入了使用 PTH 类似物治疗急性骨折的成年人的随机对照试验。将 PTH 与对照干预、安慰剂或不治疗进行比较。
PTH 类似物治疗可改善多种骨折类型的功能结局，但不会影响骨折愈合率或减轻疼痛。本综述纳入的大多数试验均为骨质疏松症老年患者。没有证据表明 PTH 治疗会造成伤害或阻碍骨折愈合。
对已发表数据的荟萃分析支持使用 PTH 类似物来改善功能结局，但不能改善不同骨折类型的愈合率或疼痛。在年轻、非骨质疏松症患者人群中，PTH 类似物在骨折愈合中的应用证据尚不明确。试验设计存在异质性且质量有限，有理由进行更多的原始试验。
