Gao Jianpeng, Liu Xiao, Wu Xiaoyong, Li Xiaoya, Liu Jianheng, Li Ming
Department of Orthopaedics, Chinese PLA General Hospital, Beijing, China.
National Clinical Research Center for Orthopedics, Sports Medicine & Rehabilitation, Beijing, China.
Front Surg. 2023 Jan 6;9:1063170. doi: 10.3389/fsurg.2022.1063170. eCollection 2022.
The risk of bisphosphonate (BP)-associated atypical femur fracture (AFF) has markedly increased over recent decades due to suppression of bone turnover, accumulation of structural micro-damage and reduction of bone remodeling consequent to long-term BP treatment. These medications further delay bone union and result in challenging clinical management. Teriparatide (TPTD), a synthetic human parathyroid hormone, exhibits unique anabolic effects and can increase bone remodeling and improve bone microarchitecture, further promoting fracture healing and reducing the rate of bone non-union. In this study, we briefly define AFF as well as the effects of BPs on AFFs, detailed the role of TPTD in AFF management and the latest clinical therapeutic findings. We have confirmed that TPTD positively promotes the healing of AFFs by reducing the time to bone union and likelihood of non-union. Thus, teriparatide therapy could be considered as an alternative treatment for AFFs, however, further research is required for the establishment of effective clinical guidelines of TPTD use in the management of AFF.
近几十年来，由于长期使用双膦酸盐（BP）抑制骨转换、结构微损伤积累以及骨重塑减少，BP相关非典型股骨骨折（AFF）的风险显著增加。这些药物会进一步延迟骨愈合，并导致具有挑战性的临床管理。特立帕肽（TPTD）是一种合成的人甲状旁腺激素，具有独特的促合成代谢作用，可增加骨重塑并改善骨微结构，进一步促进骨折愈合并降低骨不愈合率。在本研究中，我们简要定义了AFF以及BP对AFF的影响，详细阐述了TPTD在AFF管理中的作用和最新临床治疗发现。我们已证实TPTD通过减少骨愈合时间和降低不愈合可能性，对AFF的愈合有积极促进作用。因此，特立帕肽疗法可被视为AFF的一种替代治疗方法，然而，需要进一步研究以建立TPTD用于AFF管理的有效临床指南。
