Abstract
Purpose. This meta-analysis is to assess the effectiveness of teriparatide in fracture healing and clinical function improvement of the osteoporotic patients. Methods. We searched PubMed, Embase, Web of Science, and the Cochrane databases for randomized and quasi-randomized controlled trials comparing teriparatide to placebo, no treatment, or comparator interventions in the osteoporotic patients. Results. Five studies with 251 patients were included. Patients treated with teriparatide therapy had a significant shorter radiological fracture healing time compared with those in the control group (mean difference [MD] −4.54 days, 95% confidence interval [CI] −8.80 to −0.28). Stratified analysis showed that lower limb group had significant shorter healing time (MD −6.24 days, 95% CI −7.20 to −5.29), but upper limb group did not (MD −1 days, 95% CI −2.02 to 0.2). Patients treated with teriparatide therapy showed better functional outcome than those in the control group (standardized mean difference [SMD] −1.02, 95% CI −1.81 to −0.22). Patients with therapy duration over 4 weeks would have better functional outcome (SMD −1.68, 95% CI −2.07 to −1.29). Conclusions. Teriparatide is effective in accelerating fracture healing and improving functional outcome of osteoporotic women. However, more clinical studies are warranted in order to determine whether the results are applicable to males and the clinical indications for teriparatide after osteoporotic fractures.
Highlights
Bisphosphonates, the synthetic analogues of pyrophosphate [1], are the most widely used medications for the treatment of osteoporosis [2, 3]
We evaluated the effectiveness of teriparatide in osteoporotic fracture healing and clinical function improvement
Our meta-analysis comprehensively and systematically reviewed the current available literature in regard to the teriparatide therapy for osteoporotic patients and found that (1) teriparatide therapy promoted osteoporotic fracture healing and the evidence of outcomes was confirmed by the GRADE system, this evidence came from only three trials; (2) teriparatide therapy improved function outcome, which was confirmed by the GRADE system as well
Summary
Bisphosphonates, the synthetic analogues of pyrophosphate [1], are the most widely used medications for the treatment of osteoporosis [2, 3]. The mechanism of bisphosphonates is that bisphosphonates accumulate in bone by binding to mineral crystals and bisphosphonates like alendronate preferentially deposit, not in newly formed bone, but beneath osteoclasts. The key pharmacological action of bisphosphonates is the inhibition of osteoclast-mediated bone resorption. Bisphosphonates inhibit the formation and aggregation of calcium phosphate crystals to prevent bone loss and improve bone strength [4]. A long-term use of bisphosphonates may decrease bone formation, which is attributed to the long-term inhibition of osteoclasts [5]. Osteoclasts play an important role in remodeling of the callus into cortical bone. Bisphosphonates may produce adverse effects on the healing process of fractures [6, 7]
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