Abstract:Patients who elected to discontinue osteoporosis treatment experienced a significant decline in the change in BMD compared to the change on teriparatide putting them at higher risk for recurrence of fragility fractures. Patients on denosumab following teriparatide had the largest increase in BMD.
“…[3] However, there has been a great interest in using TPTD to enhance fracture healing or to treat nonunion is off-label with potent bone-forming effects. [4,5] The existing basic science data suggest TPTD accelerate chondrocyte recruitment and differentiation, which are essential processes in early enchondral ossification. [6,7] Thus TPTD enhance fracture healing by improving the biomechanical properties of the fracture callus, increasing both cartilaginous and mineralized callus formation.…”
We conducted an updated review of the evidence of teriparatide (TPTD) for fracture healing for the following questions. (1) Does it decrease fracture healing time?; (2) Can it be an alternative treatment for nonunion?; (3) Does it aid the union of atypical femoral fracture (AFF)? We searched PubMed, EMBASE, and Cochrane Library including "Fracture" AND "nonunion" AND "Teriparatide". In total, 57 publications met our inclusion criteria were summarized. This systemic review of the available literature revealed that TPTD works positively with regard to enhancing fracture healing time and union of AFF. There are also many case studies on the use of TPTD could be a potential new safe treatment for nonunion with no side effects. However, level 1 studies on the evidence of TPTD are still lacking so far. Over the last decade, a growing body of evidence has accumulated suggesting that TPTD can be an adjunct to enhance fracture healing or a therapeutic option to treat nonunion, but greater evidences from large volume prospective trials are needed.
“…[3] However, there has been a great interest in using TPTD to enhance fracture healing or to treat nonunion is off-label with potent bone-forming effects. [4,5] The existing basic science data suggest TPTD accelerate chondrocyte recruitment and differentiation, which are essential processes in early enchondral ossification. [6,7] Thus TPTD enhance fracture healing by improving the biomechanical properties of the fracture callus, increasing both cartilaginous and mineralized callus formation.…”
We conducted an updated review of the evidence of teriparatide (TPTD) for fracture healing for the following questions. (1) Does it decrease fracture healing time?; (2) Can it be an alternative treatment for nonunion?; (3) Does it aid the union of atypical femoral fracture (AFF)? We searched PubMed, EMBASE, and Cochrane Library including "Fracture" AND "nonunion" AND "Teriparatide". In total, 57 publications met our inclusion criteria were summarized. This systemic review of the available literature revealed that TPTD works positively with regard to enhancing fracture healing time and union of AFF. There are also many case studies on the use of TPTD could be a potential new safe treatment for nonunion with no side effects. However, level 1 studies on the evidence of TPTD are still lacking so far. Over the last decade, a growing body of evidence has accumulated suggesting that TPTD can be an adjunct to enhance fracture healing or a therapeutic option to treat nonunion, but greater evidences from large volume prospective trials are needed.
“…[ 53 ] Therefore, to maintain the beneficial anti-fracture effects, it is recommended to continue antiresorptive agents following the treatment discontinuation, which leads to further BMD gain in previous studies. [ 54 – 57 ] On the other hand, cyclic teriparatide treatment (3 months of treatment followed by 3 months off) showed a similar increase in BMD compared to daily treatment, which implies discontinuation of teriparatide within 3 months is unlikely to cause harm to patients. [ 58 ]…”
Section: Strategies In Pharmacological Treatmentmentioning
Osteoporosis does not take a break while Coronavirus disease 2019 (COVID-19) stunned and overtook everyone's lives. Medical resources were immediately shifted, self-isolation and telemedicine were expanded, ambulatory care services such as bone densitometry and osteoporosis-centered clinics came to a near halt. Progress with fracture prevention has been challenged because osteoporotic fracture with low energy injury is more prevalent even though restriction of people' s movement. Thus we must re-engage with chronic bone health concerns and fracture prevention. This review discusses challenges in management of osteoporosis during the COVID-19 pandemic and reinforces the need to implementing recommendations concerning the importance of bone fragility care with at least those patients who are already treated with antiosteoporotic drugs maintaining their adherence to treatments.
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