J Korean Fract Soc.  2012 Oct;25(4):295-299. 10.12671/jkfs.2012.25.4.295.

Intermittent Parathyroid Hormone Treatment for Stimulation of Callus Formation in Elderly Patients

• Song HK
• Kim SJ
• Lee JH
• Yang KH

• KMID: 1434069
• DOI: http://doi.org/10.12671/jkfs.2012.25.4.295

Abstract

PURPOSE
The purpose of this study was to evaluate the effect of parathyroid hormone (PTH) on fracture healing in elderly patients.
MATERIALS AND METHODS
We analyzed the radiologic results in 14 patients. Group I (n=7) was administrated intermittent PTH after surgical treatment and group II (n=7) was treated only with surgery. We checked the time of initial callus formation, bridging callus formation, and bone union through periodic follow-up radiographs by a radiologist who did not know the patient's information.
RESULTS
The mean time to initial callus formation was 6 weeks for group I, compared with 6.7 weeks for group II. The mean time to bridging callus formation was 15.9 weeks for group I, compared with 23.0 weeks for group II. The mean time to bone union was 28.7 weeks for group I, compared with 41.9 weeks for group II. The difference in the cumulative detection rate (CDR) of the initial callus formation of group I and II was not statistically significant (p=0.793). However, the CDR of the bridging callus formation and bone union for group I were higher than those of group II (p=0.008, p=0.001, respectively).
CONCLUSION
The intermittent PTH administration after surgical treatment and maximum possible preservation of the periosteum in elderly patients accelerates fracture healing.

Keyword

Fracture healing; Parathyroid hormone

MeSH Terms

Aged
Bony Callus
Deoxycytidine
Follow-Up Studies
Fracture Healing
Humans
Parathyroid Hormone
Periosteum
Deoxycytidine
Parathyroid Hormone

Figure

• 

  Fig. 1 Comparison of cumulative detection rate curves on a time-dependent graph for the bridging callus formation in group I and II. Group I was statistically superior to group II (p=0.008). PTH: Parathyroid hormone.

• 

  Fig. 2 Comparison of cumulative detection rate curves on a time-dependent graph for the bone union in group I and II. Group I was statistically superior to group II (p=0.001). PTH: Parathyroid hormone.

• 

  Fig. 3 Comparison of cumulative detection rate (CDR) curves on a time-dependent graph for the initial callus formation in group I and II. The time represents the period beginning at the operation and is designated along the X-axis whenever positive findings were found for each curve. The difference in the CDR of group I and II was not statistically significant (p=0.793). PTH: Parathyroid hormone.

Reference

1. Alkhiary YM, Gerstenfeld LC, Krall E, et al. Enhancement of experimental fracture-healing by systemic administration of recombinant human parathyroid hormone (PTH 1-34). J Bone Joint Surg Am. 2005. 87:731–741.

2. Aspenberg P, Genant HK, Johansson T, et al. Teriparatide for acceleration of fracture repair in humans: a prospective, randomized, double-blind study of 102 postmenopausal women with distal radial fractures. J Bone Miner Res. 2010. 25:404–414.

3. Bak B, Andreassen TT. The effect of aging on fracture healing in the rat. Calcif Tissue Int. 1989. 45:292–297.

4. Christian K, Thomas G. Robert WB, James DH, Charles MC, editors. Principles of internal fixation. Fractures in adults. 2005. 6th ed. Philadelphia: Lippincott-Raven;209–256.

5. Magnus KK, Karl JO, Per OJ. Robert WB, James DH, Charles MC, editors. Osteoporotic fractures. Fractures in adults. 2005. 6th ed. Philadelphia: Lippincott-Raven;614–641.

6. McCann RM, Colleary G, Geddis C, et al. Effect of osteoporosis on bone mineral density and fracture repair in a rat femoral fracture model. J Orthop Res. 2008. 26:384–393.

7. Naik AA, Xie C, Zuscik MJ, et al. Reduced COX-2 expression in aged mice is associated with impaired fracture healing. J Bone Miner Res. 2009. 24:251–264.

8. Peichl P, Holzer LA, Maier R, Holzer G. Parathyroid hormone 1-84 accelerates fracture-healing in pubic bones of elderly osteoporotic women. J Bone Joint Surg Am. 2011. 93:1583–1587.

9. Skripitz R, Aspenberg P. Implant fixation enhanced by intermittent treatment with parathyroid hormone. J Bone Joint Surg Br. 2001. 83:437–440.

10. Watanabe Y, Matsushita T, Bhandari M, Zdero R, Schemitsch EH. Ultrasound for fracture healing: current evidence. J Orthop Trauma. 2010. 24:Suppl 1. S56–S61.