BoneKEy Reports | BoneKEy Watch
PTH: does it improve fracture healing?
DOI:10.1038/bonekey.2013.88
Per Aspenberg reviews the evidence that parathyroid hormone (PTH), currently used in two formulations to treat osteoporosis, can stimulate fracture repair.
Experiments in rats demonstrating accelerated healing of tibial shaft fractures date back to 1999. Building on these early studies, researchers have demonstrated that a high dose of PTH significantly increases trabecular bone formation and cancellous healing in various rat fracture models. Numerous studies in other species at a variety of fracture sites and under different pathological conditions have also demonstrated that PTH treatment significantly improves fracture healing.
In humans, it is a different story. One randomized controlled trial failed to show that a dose of PTH than that normally used to treat osteoporosis (40 μg) could reduce the time required for cortical continuity in patients with distal radial fractures. However, as Aspenberg points out, re-examination of the radiographs revealed that PTH treatment did increase bony callus formation, but this was not sufficient to impact on cortical continuity. A separate trial in elderly women with osteoporotic pelvis fractures appeared to show a benefit for PTH treatment, but details in the results led to some questions about methodology, rendering the findings unreliable.
Editor’s comment: This is an excellent summary of the PTH and fracture healing story so far. Despite convincing evidence from animal experiments that PTH can enhance normal fracture healing, its benefits in humans have yet to be demonstrated conclusively.
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