Low acceptance of osteoanabolic therapy with parathyroid hormone in patients with fragility fracture of the pelvis in routine clinical practice: a retrospective observational cohort study

Abstract

Introduction A recent randomized controlled trial has reported full patient compliance and no adverse events from therapy with parathyroid hormone (PTH) for osteoporosis and accelerated healing of fragility fractures of the pelvis. The purpose of the presented study was to evaluate if similar results can be achieved with comprehensive PTH therapy in routine clinical practice. We hypothesised that patients' burden of PTH therapy is underestimated in the literature. Patients and methods Osteoanabolic PTH therapy was recommended to 79 patients suffering from an acute fragility fracture of the pelvis (FFP). Case finding, initiation of therapy and follow-up were performed by a fracture liaison service team. Primary outcome was PTH initiation rate. Secondary outcomes were implementation rate of alternative antiresorptive pharmaceutical therapy for osteoporosis and participation rate in a bone metabolic workup. Adverse events and effects potentially related to the therapy with bone-active drugs were documented as exploratory outcomes. Results Osteoanabolic PTH therapy as suggested was accepted by 32%, whereas antiresorptive therapy was implemented in another 14% of the patients. DEXA scans were available in 38% of the patients (+ 27% when compared to baseline). A bone-specific laboratory analysis was done in 18 patients, uncovering 7 pathological findings. Two patients terminated PTH therapy early because of side effects. Conclusion The experiences with PTH therapy in FFP patients with respect to, implementation rate, frequency of side effects and of pathological findings in laboratory controls as reported from a previous RCT could not be reproduced in routine clinical practice.

Isolated Pubic Ramus Fractures Are Serious Adverse Events for Elderly Persons: An Observational Study on 138 Patients with Fragility Fractures of the Pelvis Type I (FFP Type I)

“…Maier et al found that only 50% of their 93 patients received anti-osteoporotic therapy [ 19 ]. Suhm et al stated that only 46% of their 50 follow-up patients received any form of anti-resorptive therapy and additional fractures occurred in 22% [ 31 ]. Although the occurrence of isolated pubic rami fractures is a serious adverse event for elderly persons, prevention of further fractures with anti-resorptive drugs seems not to be widely accepted.…”

“…Although the occurrence of isolated pubic rami fractures is a serious adverse event for elderly persons, prevention of further fractures with anti-resorptive drugs seems not to be widely accepted. One important part of geriatric co-management is exploration of bone metabolism and treatment of osteoporosis for the prevention of the occurrence of additional fragility fractures [ 29 , 31 ].…”

Does Teriparatide Improve Fracture Union?: A Systematic Review

“…[22,23] Intermittent TPTD administration also has been reported to accelerate pelvic fracture and distal radial fracture healing by enhancing callus formation. [24][25][26] Sixty-five patients who had been treated with pelvic fractures divided into 21 patients received a once-daily injection of 100 mg of PTH 1-84, and 44 patients served as the control group. At week 8, all fractures in the treatment group and 4 fractures in the control group had healed (healing rate, 100% vs. 9.1%) and mean pain and function score (time up and go test, 22.9 vs. 54.3 sec; P<0.001), even nonunion was not detected at the latest visit.…”

“…Intermittent TPTD administration also has been reported to accelerate pelvic fracture and distal radial fracture healing by enhancing callus formation [ 24 - 26 ]. Sixty-five patients who had been treated with pelvic fractures divided into 21 patients received a once-daily injection of 100 mg of PTH 1-84, and 44 patients served as the control group.…”

Clinical Guidelines for the Diagnosis and Treatment of Fragility Fractures of the Pelvis

“…The indications for drug therapy include a history of fragility fractures, T value <−2.5 or T value > − 1 but <−2.5, and other risk factors. Previous studies have shown that drug therapy is effective in the treatment of osteoporosis and in the reduction of fracture risk 95,96 …”