HSS Journal

, Volume 5, Issue 2, pp 149-153

Recent Advances Toward the Clinical Application of PTH (1-34) in Fracture Healing

  • Cara A. CiprianoAffiliated withUniversity of Pennsylvania School of Medicine
  • , Paul S. IssackAffiliated withOrthopaedic Trauma Service, Hospital for Special SurgeryOrthopaedic Trauma and Adult Reconstructive Surgery, Hospital for Special Surgery Email author 
  • , Lisa ShindleAffiliated withMetabolic Bone Disease Service, Hospital for Special Surgery
  • , Clément M. L. WernerAffiliated withOrthopaedic Trauma Service, Hospital for Special Surgery
  • , David L. HelfetAffiliated withOrthopaedic Trauma Service, Hospital for Special SurgeryWeill-Cornell Medical Center
  • , Joseph M. LaneAffiliated withMetabolic Bone Disease Service, Hospital for Special Surgery

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Abstract

PTH 1-34, an active form of parathyroid hormone, has been shown to enhance osteoblastic bone formation when administered as a daily subcutaneous injection. The effect of the intermittent administration of PTH (1-34) is an uncoupling of bone turnover with an increase in bone mass and density and decrease in risk of vertebral and nonvertebral fractures. While PTH (1-34) has been used clinically to increase bone mass and reduce fracture risk in postmenopausal women with osteoporosis, there is increasing evidence that PTH (1-34) may promote fracture healing. Animal studies have demonstrated accelerated callus formation with enhanced remodeling and biomechanical properties of the healing fracture. Given these effects, PTH (1-34) will likely be used clinically to enhance fracture union in poor healing situations such as osteoporosis and recalcitrant nonunions.