Mishra Sanket, Satapathy Deepankar, Samal Sidhartha, Zion Nego, Lodh Udeepto
Department of Orthopedic Surgery, Institute of Medical Sciences & SUM Hospital, Bhubaneswar, IND.
Cureus. 2022 Jun 22;14(6):e26190. doi: 10.7759/cureus.26190. eCollection 2022 Jun.
With improved life expectancy and ever-increasing geriatric population with concomitant osteoporosis, there is increase in osteoporotic intertrochanteric hip fractures. Even the best surgical advances fail to provide satisfactory and early results. As a result, researchers' focus has lately shifted to developing a more integrated approach that combines the pharmacotherapeutic capabilities of teriparatide, a recombinant version of human parathyroid hormone (1-34), a new anabolic drug that enhances bone mass and strength by promoting osteoblastic activity and hastens fracture union in both human and animals. We attempted to evaluate the therapeutic efficiency of teriparatide therapy on outcomes of surgically managed Intertrochanteric hip fractures in osteoporotic patients. A total of 31 patients with established osteoporosis and Intertrochanteric fractures were selected and divided into two groups, managed surgically with proximal femur nailing, and then prospectively compared with one group receiving teriparatide therapy in addition to standard treatment after taking necessary consent and allocation into two groups based on the preference of patients to take additional teriparatide or not after understanding the benefits and risks involved. We aimed to assess the functional and radiological effects of teriparatide on bone mineral density, the time taken for fracture union, and other fracture-related postoperative complications such as weight bearing and residual bone pain. All patients were followed up at 6, 12, and 24 weeks. Time to fracture union was significantly shortened, with considerable improvement in bone density and functional outcome in the teriparatide group. Varus collapse, the rate of migration of the helical blade, and shortening of the femoral neck were also significantly less in the study group. From the assembled data, we can safely assume that with early union rates with better functional improvement with additional advantage of increased bone mass, we favor supplemental teriparatide therapy in the management of osteoporotic patients with femoral intertrochanteric fractures to augment healing. Further studies with a larger sample size are required to support our observation.
随着预期寿命的提高以及老年人口的不断增加，同时伴有骨质疏松症，骨质疏松性股骨转子间髋部骨折的发生率也在上升。即使是最好的外科进展也未能提供令人满意的早期效果。因此，研究人员最近的重点已转向开发一种更综合的方法，该方法结合了特立帕肽的药物治疗能力，特立帕肽是重组人甲状旁腺激素（1-34），这是一种新型合成代谢药物，通过促进成骨细胞活性来增加骨量和骨强度，并加速人和动物的骨折愈合。我们试图评估特立帕肽治疗对骨质疏松患者手术治疗的股骨转子间髋部骨折结局的治疗效果。总共选择了31例确诊为骨质疏松症和股骨转子间骨折的患者，分为两组，采用股骨近端髓内钉进行手术治疗，然后在获得必要的同意并根据患者在了解相关益处和风险后是否愿意接受额外特立帕肽的偏好将其分为两组后，对一组在标准治疗基础上接受特立帕肽治疗的患者进行前瞻性比较。我们旨在评估特立帕肽对骨密度、骨折愈合时间以及其他与骨折相关的术后并发症（如负重和残余骨痛）的功能和放射学影响。所有患者在6周、12周和24周时进行随访。特立帕肽组的骨折愈合时间明显缩短，骨密度和功能结局有显著改善。研究组内翻塌陷、螺旋刀片移位率和股骨颈缩短也明显较少。从汇总的数据来看，我们可以有把握地认为，由于早期愈合率更高，功能改善更好，还有增加骨量的额外优势，我们支持在骨质疏松性股骨转子间骨折患者的治疗中补充特立帕肽治疗以促进愈合。需要进行更大样本量的进一步研究来支持我们的观察结果。
