The effectiveness and safety of parathyroid hormone in fracture healing: A meta-analysis

Abstract

The very large economic and social burdens of fracture-related complications make rapid fracture healing a major public health goal. The role of parathyroid hormone (PTH) in treating osteoporosis is generally accepted, but the effect of PTH on fracture healing is controversial. This meta-analysis was designed to investigate the efficacy and safety of PTH in fracture healing. The EMBASE, PubMed, and Cochrane Library databases were systematically searched from the inception dates to April 26, 2018. The primary randomized clinical trials comparing PTH treatment for fracture healing with placebo or no treatment were identified. We did not gain additional information by contacting the authors of the primary studies. Two reviewers independently extracted the data and evaluated study quality. This meta-analysis was executed to determine the odds ratio, mean difference, standardized mean difference, and 95% confidence intervals with random-effects models. In total, 8 randomized trials including 524 patients met the inclusion criteria. There were significant differences in fracture healing time, pain relief and function improvement. There were no significant differences in the fracture healing rate or adverse events, including light-headedness, hypercalcemia, nausea, sweating and headache, except for slight bruising at the injection site. We determined that the effectiveness and safety of PTH in fracture healing is reasonably well established and credible.

Effect of Recombinant Human Parathyroid Hormone (1-84) on Resolution of Active Charcot Neuro-osteoarthropathy in Diabetes: A Randomized, Double-Blind, Placebo-Controlled Study

“…Thus, therapy of CN with PTH did not enhance bone repair. This is in contrast to findings from a recent meta-analysis that reported significant clinical value of PTH therapy on healing of non-Charcot factures ( 23 ).…”

Clinical Application of Bone Marrow Mesenchymal Stem/Stromal Cells to Repair Skeletal Tissue

“…A meta-analysis study based on eight randomized trials has shown that injection of PTH is also safe and effective in treating fracture repair. Patients treated with PTH displayed accelerated fracture healing [ 120 ]. Other researchers are currently investigating whether local delivery/release of PTH via either cell-free biomimetic nanofibrous scaffold or hydrogel embedded in a porous poly scaffold are more advantageous for bone healing compared to systemic administration via injection of PTH using rodent preclinical models [ 121 , 122 ].…”

The effect of osteoporosis and its treatment on fracture healing a systematic review of animal and clinical studies

“…They included four studies performed in an osteoporotic fracture population 89 , 90 , 91 , 92 and two with an unknown osteoporosis status 93 , 94 . Another meta-analysis in 2019 investigated the efficacy and safety of r-PTH in fracture healing [95] . This meta-analysis included the eight RCTs that were identified in the present search; three studies were performed in an osteoporotic fracture population 89 , 96 , 97 , in four studies osteoporosis status was unknown 93 , 94 , 98 , 99 and one including both osteoporotic and non osteoporotic patients [100] .…”