Efficacy of long-term treatment with Teriparatide on osteoporotic intertrochanteric fracture in the elderly

Abstract

Objective To observe the efficacy of long-term treatment with Teriparatide on osteoporotic intertrochanteric fracture in the elderly. Methods The elderly patients with osteoporotic intertrochanteric fracture meeting inclusion and exclusion criteria were recruited.They received proximal femoral nail anti-rotation(PFNA)surgery with the combined intakes of calcium of 600 mg/day and 1-alpha, 25-(OH)2-vitamin D3 analogs of 0.5 μg/day as a basic standard treatment protocol(BSTP). The study subjects included control group(n=10)who underwent PFNA surgery plus oral calcium and vitamin D supplements without teriparatide(20 μg/d), and the observation group who received PFNA surgery plus oral calcium and vitamin D supplements with teriparatide(20 μg/d), for more than twelve months or over at our department from October 2012 to February 2016.Gender, age, socio-demographics and clinical values of the American Society of Anesthesiologists(ASA)score, fracture types, preoperative serum albumin level, preoperative BMI, bone mineral density 1 week postoperatively, serum N-terminal propeptide of type I collagen(PINP)and C-terminal telopeptides of type 1 collagen(β-CTX)1 week postoperatively were matched between the two groups, no statistically significant difference was found(all P>0.05). Levels of PINP and β-CTX 3, 6 and 12 months postoperatively, BMD 1 year postoperatively, fracture healing time and complications were compared between the two groups.The prognosis of 1 case of patient undergoing conservative treatment was observed. Results There was no significant difference between the two groups in serum levels of PINP and β-CTX 1 week postoperatively(P=0.362 and 0.517, respectively). Serum level of PINP was significantly increased in observation group at 3, 6 and 12 months postoperatively versus at 1 week postoperatively(P=0.008, 0.001 and 0.004, respectively), while serum level of PINP had no significant difference in control group at 3, 6 and 12 months postoperatively versus at 1week postoperatively(P>0.05). Serum levels of PINP 3, 6 and 12 months postoperatively were higher in the observation group than in control(P=0.002, 0.002 and 0.000, respectively). In the observation group, serum β-CTX level reached the peak at 6 months after surgery, which was higher than that at 1 week after surgery(P=0.041), and slowly decreased at 12 months after surgery.In the control group, β-CTX slowly increased at 3, 6 and 12 months postoperatively versus at 1 week postoperatively(P>0.05). There was no significant difference in BMD of lumbar spine and contralateral hip between the two groups at 1 week postoperatively(P=0.440 and 0.325). At 1 year postoperatively versus at 1 week postoperatively, the BMD of lumbar spine and contralateral hip was increased(P=0.039 and 0.009)in the observation group, while was decreased(P>0.05)in control group.The fracture healing time was shorter in observation group than in control group(13.6±2.2 weeks vs.17.6±3.4 weeks, P=0.033). No one had a delayed fracture healing in observation group and 1 patient showed a delayed fracture healing in the control group.There were no complications such as lag screw sliding, refracture, pressure ulcer and deep vein thrombosis in both groups.The fracture nonunion was found in the patient undergoing conservative treatment after 20 months of teriparatide treatment. Conclusions The medium-and long-term of teriparatide treatment can significantly promote bone formation, improve BMD of the lumbar spine and hip, and shorten fracture healing time in patients with osteoporotic intertrochanteric fracture, but it is not a substitute for surgical treatment. Key words: Osteoporosis; Hip fractures; Teriparatide