The Role of Recombinant PTH in Human Fracture Healing: A Systematic Review

Objectives:Human parathyroid hormone (PTH) is known to be efficacious in the treatment of osteoporosis and reduction of risk of vertebral and nonvertebral fractures; however, its role in the enhancement of human fracture healing is controversial. Our objective is to conduct a systematic literature review on the use of recombinant PTH in human fracture healing to (1) evaluate the evidence for recombinant PTH in human fracture healing and (2) assess whether there are notable differences between previous case reports and prospective trials.Data Sources:We performed a literature search in PubMed, EMBASE, Web of Science, and the Cochrane Database of Systematic Reviews for teriparatide, PTH (1-84), fracture, and healing.Study Selection:References of retrieved articles were screened for additional studies, and exclusion criteria were applied.Data Extraction:Due to the limited publications on the subject, case reports and case series were included in our data analysis.Data Synthesis:Due to the limited publications on the subject, our data are presented in simple tabular format.Conclusions:Our literature review yielded 16 publications on the use of recombinant PTH in human fracture healing and 2 randomized controlled trial with 1 retrospective subgroup analysis. There continues to be anecdotal evidence for the use of recombinant PTH to enhance fracture healing. There are discrepancies in study design in the randomized controlled trials and the majority of case reports and, additional prospective studies are warranted.