J Bone Metab.  2012 Nov;19(2):147-151. 10.11005/jbm.2012.19.2.147.

Parathyroid Hormone 1-34(Teriparatide) Treatment in Pelvic Insufficiency Fractures: A Report of Two Cases

• Moon SW
• Lee DH
• Kim YC
• Kim YB
• Lee SJ
• Kim JW

• KMID: 1975989
• DOI: http://doi.org/10.11005/jbm.2012.19.2.147

Abstract

As a result of aging population, the incidence of pelvic insufficiency fracture has been increasing. Pain-related immobility caused by pelvic insufficiency fractures may result in a serious dependency and high mortality with preexisting comorbidities. We present two cases of pelvic insufficiency fracture in elderly patients which had good clinical outcome by parathyroid hormone 1-34(teriparatide) treatment as well as a literature review.

Keyword

Osteoporosis; Parathyroid hormone; Pelvis; Pelvis (Pelvic) insufficiency fracture

MeSH Terms

Aged
Aging
Comorbidity
Dependency (Psychology)
Fractures, Stress
Humans
Incidence
Osteoporosis
Parathyroid Hormone
Pelvis
Parathyroid Hormone

Figure

• 

  Fig. 1 (A) Pelvis anteroposterior view radiograph shows left superior and inferior rami fractures (black arrow), (B) Coronal image of bone single photon emission computed tomography shows hot uptake of left sacrum suggesting fractures (black arrow), (C) Axial computed tomography image shows cortical disruption of sacral alar (black arrow).

• 

  Fig. 2 (A) Radiograph of Pelvis anteroposterior (AP) taken 4 weeks after injury shows callus formation (black arrow) of fracture site, (B) Radiograph of Pelvis AP taken 12 weeks shows progressly increased density (black arrow).

• 

  Fig. 3 (A) Pelvis anteroposterior radiograph view demonstrats right superior and inferior rami fractures (black arrow), (B) Axial computed tomography image shows cortical disruption of left sacral alar (black arrow).

• 

  Fig. 4 (A) Radiograph of Pelvis anteroposterior (AP) taken 4 weeks after injury shows callus formation (black arrow) of fracture site, (B) Radiograph of Pelvis AP taken 12 weeks shows progressly increased density (black arrow).

Reference

1. Johnell O, Kanis J. Epidemiology of osteoporotic fractures. Osteoporos Int. 2005. 16:Suppl 2. S3–S7.

2. Kannus P, Palvanen M, Parkkari J, et al. Osteoporotic pelvic fractures in elderly women. Osteoporos Int. 2005. 16:1304–1305.

3. Krappinger D, Kammerlander C, Hak DJ, et al. Low-energy osteoporotic pelvic fractures. Arch Orthop Trauma Surg. 2010. 130:1167–1175.

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

5. Beall DP, D'Souza SL, Costello RF, et al. Percutaneous augmentation of the superior pubic ramus with polymethyl methacrylate: treatment of acute traumatic and chronic insufficiency fractures. Skeletal Radiol. 2007. 36:979–983.

6. Buffum MD, Hutt E, Chang VT, et al. Cognitive impairment and pain management: review of issues and challenges. J Rehabil Res Dev. 2007. 44:315–330.

7. Thomas EN, Cyteval C, Herisson C, et al. Osteoporotic fracture of the sacrum: sacroplasty and physical medecine. Ann Phys Rehabil Med. 2009. 52:427–435.

8. 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.

9. Andreassen TT, Fledelius C, Ejersted C, et al. Increases in callus formation and mechanical strength of healing fractures in old rats treated with parathyroid hormone. Acta Orthop Scand. 2001. 72:304–307.

10. Weber M, Hasler P, Gerber H. Insufficiency fractures of the sacrum. Twenty cases and review of the literature. Spine (Phila Pa 1976). 1993. 18:2507–2512.