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document
Teriparatide improves early callus formation in distal radial fractures . BACKGROUND Teriparatide ( parathyreoid hormone ; PTH 1-34 ) increases skeletal mass in humans and improves fracture healing in animals . A recent randomized multicenter trial of nonoperated distal radial fractures showed a moderate shortening of the time to restoration of cortical continuity by treatment with 20 microg ( low-dose ) teriparatide per day , but not with 40 microg ( high-dose ) . As radiographic cortical continuity appears late in the healing process , perhaps too late for clinical relevance , we studied the qualitative appearance of the callus 5 weeks after fracture . METHODS One third of the patients of the international trial were treated at Linköping University Hospital . The multicenter trial did not evaluate early callus formation . We therefore made a blinded qualitative scoring of the callus at 5 weeks in our 27 patients . Callus formation was arbitrarily classified as rich , intermediate , or poor . RESULTS 9 patients were classified as rich ( none had received placebo , 3 low-dose teriparatide , and 6 high-dose teriparatide ) . 9 patients were classified as intermediate ( 1 had received placebo , 5 low-dose , and 3 high-dose ) . 9 patients were classified as poor ( 7 had received placebo , 1 low-dose , and 1 high-dose ) ( p < 0.001 ) . INTERPRETATION This is a post hoc subgroup analysis of an outcome variable , which was not in the official protocol . The results must therefore be interpreted with caution . However , in combination with the results of the larger trial , the data suggest that radiographic quality at an early time point might be a sensitive variable , perhaps better than time to cortical continuity . Moreover , teriparatide appeared to improve early callus formation in distal radial fractures .
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Intervention_Pharmacological
20 microg ( low-dose ) teriparatide
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Intervention_Control
not with 40 microg ( high-dose )
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Outcome_Physical
early callus formation
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Participant_Condition
distal radial fractures .
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Participant_Condition
nonoperated distal radial fractures