Osteoporosis International

, Volume 23, Issue 12, pp 2897–2900 | Cite as

Teriparatide, a nonsurgical solution for femoral nonunion? A report of three cases

Case Report


We medicated teriparatide in three patients, who had a nonunion of the femur even after the initial surgical intervention. Teriparatide was administered for 3–9 months after a diagnosis of nonunion. A successful union was obtained in all three patients without further surgical intervention, and no adverse events related to the use of teriparatide were observed. Our report showed that teriparatide could be an alternative to surgical intervention in nonunion of the femur.


  1. 1.
    Neer RM, Arnaud CD, Zanchetta JR, Prince R, Gaich GA, Reginster JY, Hodsman AB, Eriksen EF, Ish-Shalom S, Genant HK, Wang O, Mitlak BH (2001) Effect of parathyroid hormone (1-34) on fractures and bone mineral density in postmenopausal women with osteoporosis. N Engl J Med 344:1434–1441PubMedCrossRefGoogle Scholar
  2. 2.
    Jiang Y, Zhao JJ, Mitlak BH, Wang O, Genant HK, Eriksen EF (2003) Recombinant human parathyroid hormone (1-34) [teriparatide] improves both cortical and cancellous bone structure. J Bone Miner Res 18:1932–1941PubMedCrossRefGoogle Scholar
  3. 3.
    Zanchetta JR, Bogado CE, Ferretti JL, Wang O, Wilson MG, Sato M, Gaich GA, Dalsky GP, Myers SL (2003) Effects of teriparatide [recombinant human parathyroid hormone (1-34)] on cortical bone in postmenopausal women with osteoporosis. J Bone Miner Res 18:539–543PubMedCrossRefGoogle Scholar
  4. 4.
    Rubin MR, Cosman F, Lindsay R, Bilezikian JP (2002) The anabolic effects of parathyroid hormone. Osteoporos Int 13:267–277PubMedCrossRefGoogle Scholar
  5. 5.
    Cipriano CA, Issack PS, Shindle L, Werner CM, Helfet DL, Lane JM (2009) Recent advances toward the clinical application of PTH (1-34) in fracture healing. HSS J 5:149–153PubMedCrossRefGoogle Scholar
  6. 6.
    Daugaard H, Elmengaard B, Andreassen TT, Baas J, Bechtold JE, Soballe K (2011) The combined effect of parathyroid hormone and bone graft on implant fixation. J Bone Joint Surg Br 93:131–139PubMedCrossRefGoogle Scholar
  7. 7.
    O’Loughlin PF, Cunningham ME, Bukata SV, Tomin E, Poynton AR, Doty SB, Sama AA, Lane JM (2009) Parathyroid hormone (1-34) augments spinal fusion, fusion mass volume, and fusion mass quality in a rabbit spinal fusion model. Spine (Phila Pa 1976) 34:121–130CrossRefGoogle Scholar
  8. 8.
    Jacobson JA, Yanoso-Scholl L, Reynolds DG, Dadali T, Bradica G, Bukata S, Puzas EJ, Zuscik MJ, Rosier R, O’Keefe RJ, Schwarz EM, Awad HA (2011) Teriparatide therapy and beta-tricalcium phosphate enhance scaffold reconstruction of mouse femoral defects. Tissue Eng Part A 17:389–398PubMedCrossRefGoogle Scholar
  9. 9.
    Aspenberg P, Genant HK, Johansson T, Nino AJ, See K, Krohn K, Garcia-Hernandez PA, Recknor CP, Einhorn TA, Dalsky GP, Mitlak BH, Fierlinger A, Lakshmanan MC (2010) Teriparatide for acceleration of fracture repair in humans: a prospective, randomized, double-blind study of 102 postmenopausal women with distal radial fractures. J Bone Miner Res 25:404–414PubMedCrossRefGoogle Scholar
  10. 10.
    Peichl P, Holzer LA, Maier R, Holzer G (2011) Parathyroid hormone 1-84 accelerates fracture-healing in pubic bones of elderly osteoporotic women. J Bone Joint Surg Am 93:1583–1587PubMedCrossRefGoogle Scholar
  11. 11.
    Puzas JE, Houck J, Bukata SV (2006) Accelerated fracture healing. J Am Acad Orthop Surg 14:S145–151PubMedGoogle Scholar
  12. 12.
    Knecht TP (2004) Teriparatide and fracture healing in cortical bone. Endocr Pract 10:293PubMedGoogle Scholar
  13. 13.
    Resmini G, Iolascon G (2007) 79-year-old post-menopausal woman with humerus fracture during teriparatide treatment. Aging Clin Exp Res 19:30–31PubMedGoogle Scholar
  14. 14.
    Marsh D (1998) Concepts of fracture union, delayed union, and nonunion. Clin Orthop Relat Res S22-30Google Scholar
  15. 15.
    Pihlajamaki HK, Salminen ST, Bostman OM (2002) The treatment of nonunions following intramedullary nailing of femoral shaft fractures. J Orthop Trauma 16:394–402PubMedCrossRefGoogle Scholar
  16. 16.
    Rodriguez-Merchan EC, Gomez-Castresana F (2004) Internal fixation of nonunions. Clin Orthop Relat Res 13-20Google Scholar
  17. 17.
    Barnes GL, Kakar S, Vora S, Morgan EF, Gerstenfeld LC, Einhorn TA (2008) Stimulation of fracture-healing with systemic intermittent parathyroid hormone treatment. J Bone Joint Surg Am 90(Suppl 1):120–127PubMedCrossRefGoogle Scholar
  18. 18.
    Brinker MR, O’Connor DP, Monla YT, Earthman TP (2007) Metabolic and endocrine abnormalities in patients with nonunions. J Orthop Trauma 21:557–570PubMedCrossRefGoogle Scholar
  19. 19.
    Mahendra A, Maclean AD (2007) Available biological treatments for complex non-unions. Injury 38(Suppl 4):S7–12PubMedCrossRefGoogle Scholar
  20. 20.
    Finkemeier CG (2002) Bone-grafting and bone-graft substitutes. J Bone Joint Surg Am 84-A:454–464PubMedGoogle Scholar
  21. 21.
    Bishop GB, Einhorn TA (2007) Current and future clinical applications of bone morphogenetic proteins in orthopaedic trauma surgery. Int Orthop 31:721–727PubMedCrossRefGoogle Scholar
  22. 22.
    Oteo-Alvaro A, Moreno E (2010) Atrophic humeral shaft nonunion treated with teriparatide (rh PTH 1-34): a case report. J Shoulder Elbow Surg 19:e22–28PubMedCrossRefGoogle Scholar
  23. 23.
    Rubery PT, Bukata SV (2010) Teriparatide may accelerate healing in delayed unions of type III odontoid fractures: a report of 3 cases. J Spinal Disord Tech 23:151–155PubMedCrossRefGoogle Scholar
  24. 24.
    Chintamaneni S, Finzel K, Gruber BL (2010) Successful treatment of sternal fracture nonunion with teriparatide. Osteoporos Int 21:1059–1063PubMedCrossRefGoogle Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2012

Authors and Affiliations

  1. 1.Department of Orthopaedic SurgerySeoul National University Bundang HospitalSeongnam-siSouth Korea
  2. 2.Department of Orthopaedic SurgeryChung-Ang University College of MedicineSeoulSouth Korea

Personalised recommendations