Teriparatide as an Adjunct in Managing Delayed Union of Long Bone Fractures: Insights from a Tertiary Care Center

Delayed union of long bone fractures presents a significant clinical challenge, often leading to prolonged morbidity and functional limitation. Teriparatide, a recombinant human parathyroid hormone (PTH 1-34), has shown promise as a biological enhancer of bone healing. This study aims to evaluate the efficacy and safety of teriparatide in promoting fracture healing in patients with delayed union.

A prospective interventional study was conducted on 48 adult patients (mean age: 42.6 ± 11.2 years) with delayed union of long bone fractures (tibia, femur, humerus, and radius/ulna) between 3 and 9 months postinjury. All patients received daily subcutaneous teriparatide (20 μg) for 3 months, along with calcium and vitamin D supplementation. Clinical outcomes were assessed using the Visual Analog Scale (VAS) and weight-bearing ability; radiological healing was assessed using the Radiographic Union Score for Tibial fractures (RUST) and cortical bridging on serial radiographs at 0, 6, and 12 weeks.

The mean VAS score significantly reduced from 7.8 ± 1.1 at baseline to 2.1 ± 0.9 at 12 weeks (P < 0.001). Radiological union was observed in 81.2% of patients at 12 weeks, with the mean RUST score improving from 5.2 ± 1.3 to 10.3 ± 1.2 (P < 0.001). Clinical union was achieved in 87.5% of patients, and 91.7% regained full weight-bearing ability. Metaphyseal fractures and fractures with stable fixation showed better outcomes. No major adverse events were reported.

Teriparatide is a safe, well-tolerated, and effective adjunct in managing delayed union of long bone fractures. It accelerates both clinical and radiological healing, reducing the need for surgical reintervention. These findings support its inclusion in the orthopedic treatment armamentarium for biologically enhancing fracture repair in selected cases.