Combined effect of teriparatide and low-intensity pulsed ultrasound for nonunion: a case report

Abstract

BackgroundLow-intensity pulsed ultrasound is a pain-free therapy performed daily at home by the patient and has been shown to promote fracture healing. Teriparatide is a parathyroid hormone preparation that activates osteoblastic bone formation and is also reported to be effective in promoting bony union.Case presentationWe report the case of a 56-year-old Japanese male with a femoral shaft fracture who underwent intramedullary osteosynthesis nailing initially. He had no radiologic or clinical sign of healing 3 months later and low-intensity pulsed ultrasound was initiated at that time. He was reassessed in another 3 months, with evidence of mild bone consolidation but the fracture gap persisted. Subsequent treatment with human parathyroid hormone was initiated in combination with low-intensity pulsed ultrasound. Full fracture healing was present 6 months after beginning the combination low-intensity pulsed ultrasound and teriparatide. It is hypothesized that the potential additive effects of low-intensity pulsed ultrasound and teriparatide therapy ultimately triggered sufficient bone formation to support osseous union.ConclusionThe case reported herein is a femoral shaft atrophic nonunion in which traditional interventions failed. Successful fracture healing was finally achieved with low-intensity pulsed ultrasound and teriparatide therapy. This is the first reported case of diaphyseal nonunion with deterioration of bone quality in long bones resolved with teriparatide and low-intensity pulsed ultrasound.

Successful Bone Healing of Nonunion After Ulnar Shortening Osteotomy for Smokers Treated With Teriparatide

“…9 Currently, several clinical studies have demonstrated that LIPUS enhances the healing of fresh fractures, delayed unions, and nonunions. 4,5 Teriparatide is a recombinant human parathyroid hormone (PTH 1-34) prepara-tion used in the treatment of osteoporosis and is expected to be a potent agent for fracture healing and nonunion. [5][6][7][8] The anabolic effect of PTH on bone is attributable to the stimulation of osteoblastic activity, and intermittent administration of PTH systemically accelerates fracture healing by augmenting fracture site chondrogenesis and osteogenesis.…”

“…4,5 Teriparatide is a recombinant human parathyroid hormone (PTH 1-34) prepara-tion used in the treatment of osteoporosis and is expected to be a potent agent for fracture healing and nonunion. [5][6][7][8] The anabolic effect of PTH on bone is attributable to the stimulation of osteoblastic activity, and intermittent administration of PTH systemically accelerates fracture healing by augmenting fracture site chondrogenesis and osteogenesis. 10 In a more detailed prospective, randomized, double-blinded study of conservative fracture treatment for 102 postmenopausal women with distal radius fractures, Aspenberg et al 8 showed that the time to healing was shorter in the 20-mg teriparatide group than in the placebo group.…”

“…Combined effects of teriparatide and LIPUS on the stimulation of bone healing have been reported in both an animal model and a clinical study. 5,15 Warden et al 15 reported that teriparatide and LIPUS had contrasting additive, rather than synergistic, effects during fracture healing in rat studies; that is, teriparatide primarily increased the callus bone mineral content, whereas LIPUS increased the callus size. Nozaka et al 5 described that successful bone healing for femoral shaft atrophic nonunion was achieved with LIPUS and teriparatide combination therapy.…”

“…4 Recently, as a noninvasive pharmacological systemic treatment for fracture healing or nonunion, teriparatide administration has been reported in several clinical studies. [5][6][7][8] However, there have been no reports about teriparatide therapy for nonunion after ulnar shortening osteotomy.…”

Enhanced bone healing and decreased pain in sacral insufficiency fractures after teriparatide treatment: retrospective clinical-based observational study

“…Teriparatide (TPTD) (1-34 parathyroid hormone [PTH]), which has been prescribed to stimulate bone formation in cases of severe osteoporosis, may prevent these problems. Several studies have reported that TPTD enhanced bone healing or bone union after fracture or osteosynthesis surgery (5,6); however, the effects of TPTD treatment of SIFs on pain, fracture healing, and mobility are still unclear. Therefore, the purpose of this study was to evaluate the clinical and radiological findings of SIFs treated with TPTD in 7 elderly women with osteoporosis.…”