Document Type : Original Article

Authors

1 Associate professor of Department of Orthopaedics, Mashhad University of Medical Sciences, Emdadi Kamyab Hospital, Mashhad, Iran.

2 Biotechnology Research Center, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran

3 Associate professor of Department of Orthopaedics, Mashhad University of Medical Sciences, Emdadi Kamyab Hospital, Mashhad, Iran

4 Resident of orthopedic surgery of Department of Orthopaedics, Mashhad University of Medical Sciences, Emdadi Kamyab Hospital, Mashhad, Iran.

5 Assistant Professor of Department of Orthopaedics, Mashhad University of Medical Sciences, Emdadi Kamyab Hospital, Mashhad, Iran.

6 Mashhad University of Medical Sciences

Abstract

Introduction
The use of parathyroid hormone in the management of fracture disorders is poorly documented. Aim of study was evaluation of parathyroid hormone efficacy on :union: of tibia/fibula diaphysis fractures.
Materials and methods:
It was a hospital-based study who conducted on patient with non-:union: or delayed-:union: fracture of tibia/fibula. At Shahid Kamyab hospital, patients with inclusion criteria, entered the study after completing the conscious consent form in both case and control groups. CBC, ESR, Ca, P, Mg, ALK-P, Cr, BUN tests were performed as baseline, then in the case group prescribe oral D-Calcium and monthly injection of parathyroid hormone for 3 months at a daily dose of 8 units and in the control group, prescribe oral D-Calcium and the expected treatment method, and those who had a specific risk factor such as digoxin tablets or kidney failure were excluded from the study. After entering the study and receiving the hormone once the month, patients evaluate with radiographic parameter. 
Results:
Of evaluated cases, mean and standard deviation of age in the intervention group was 16.9 ± 37.7 years and in the control group was 13.8 ± 39.1 years (P = 0.73). In terms of gender in the two groups, 24 cases were male and 6 cases were female (P = 1.0). In addition in clinical findings, fracture type (P = 1.0), fracture shape (P = 0.18), fixation method (P = 0.26), radiographical result (P = 0.06) did not have a statistically significant difference between the two groups.
Conclusion:
We not find any positive effect of this hormon on fracture status, as clinical or para clinical evaluation.

Keywords

Main Subjects

  1. Yakubovich DC, Sheyn D, Bez M, Schary Y, Yalon E, Sirhan A, et al. Systemic administration of mesenchymal stem cells combined with parathyroid hormone therapy synergistically regenerates multiple rib fractures. Stem cell research & therapy. 2017;8(1):51.
  2. Noordin S, Glowacki J. Parathyroid hormone and its receptor gene polymorphisms: implications in osteoporosis and in fracture healing. Rheumatology international. 2016;36(1):1-6.
  3. Keblawi SS, Wright JN, Otjen JP, Verma A, Brown EC, Ness KD, et al. Multiple Abusive Fractures in an Infant With a Concurrent Parathyroid Hormone-Related Peptide-Secreting Renal Tumor: Abusive Fractures Accompanying a Parathyroid Hormone-Related Peptide-Secreting Tumor. Pediatric Emergency Care. 2019.
  4. Mansjur KQ, Kuroda S, Izawa T, Maeda Y, Sato M, Watanabe K, et al. The effectiveness of human parathyroid hormone and low-intensity pulsed ultrasound on the fracture healing in osteoporotic bones. Annals of biomedical engineering. 2016;44(8):2480-8.
  5. Dretakis K, Igoumenou VG. The role of parathyroid hormone (PTH) and vitamin D in falls and hip fracture type. Aging clinical and experimental research. 2019;31(10):1501-7.
  6. Yamashita J, McCauley LK. Effects of Intermittent Administration of Parathyroid Hormone and Parathyroid Hormone‐Related Protein on Fracture Healing: A Narrative Review of Animal and Human Studies. JBMR plus. 2019;3(12):e10250.
  7. Liu G, Cao G, Tian F, Song H, Yuan L, Geng L, et al. Parathyroid hormone (1–34) promotes fracture healing in ovariectomized rats with type 2 diabetes mellitus. Osteoporosis International. 2017;28(10):3043-53.
  8. Morgan EF, Mason ZD, Chien KB, Pfeiffer AJ, Barnes GL, Einhorn TA, et al. Micro-computed tomography assessment of fracture healing: relationships among callus structure, composition, and mechanical function. Bone. 2009;44(2):335-44.
  9. Jansz T, Goto N, van Ballegooijen A, Willems H, Verhaar M, van Jaarsveld B. The prevalence and incidence of vertebral fractures in end-stage renal disease and the role of parathyroid hormone. Osteoporosis International. 2020;31(3):515-24.
  10. Andreassen TT, Ejersted C, Oxlund H. Intermittent parathyroid hormone (1–34) treatment increases callus formation and mechanical strength of healing rat fractures. Journal of bone and mineral research. 1999;14(6):960-8.
  11. Neer RM, Arnaud CD, Zanchetta JR, Prince R, Gaich GA, Reginster J-Y, et al. Effect of parathyroid hormone (1-34) on fractures and bone mineral density in postmenopausal women with osteoporosis. New England journal of medicine. 2001;344(19):1434-41.
  12. Milstrey A, Wieskoetter B, Hinze D, Grueneweller N, Stange R, Pap T, et al. Dose-dependent effect of parathyroid hormone on fracture healing and bone formation in mice. Journal of Surgical Research. 2017;220:327-35.
  13. Suhm N, Egger A, Zech C, Eckhardt H, Morgenstern M, Gratza S. 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. Archives of Orthopaedic and Trauma Surgery. 2020;140(3):321-9.
  14. Lou S, Lv H, Wang G, Zhang L, Li M, Li Z, et al. The effect of teriparatide on fracture healing of osteoporotic patients: a meta-analysis of randomized controlled trials. BioMed research international. 2016;2016.
  15. Shi Z, Zhou H, Pan B, Lu L, Liu J, Kang Y, et al. Effectiveness of teriparatide on fracture healing: a systematic review and meta-analysis. PLoS One. 2016;11(12):e0168691.
  16. Aspenberg P, Genant HK, Johansson T, Nino AJ, See K, Krohn K, et al. Teriparatide for acceleration of fracture repair in humans: a prospective, randomized, double‐blind study of 102 postmenopausal women with distal radial fractures. Journal of Bone and Mineral Research. 2010;25(2):404-14.
  17. Peichl P, Holzer LA, Maier R, Holzer G. Parathyroid hormone 1-84 accelerates fracture-healing in pubic bones of elderly osteoporotic women. JBJS. 2011;93(17):1583-7.
  18. Bukata SV, Puzas JE. Orthopedic uses of teriparatide. Current osteoporosis reports. 2010;8(1):28-33.
  19. Resmini G, Iolascon G. 79-year-old post-menopausal woman with humerus fracture during teriparatide treatment. Aging clinical and experimental research. 2007;19(4 Suppl):30-1.