Effectiveness of parathyroid hormone (PTH) analogues on fracture healing: a meta-analysis

Abstract

Summary

This meta-analysis evaluated the evidence for the use of parathyroid hormone (PTH) analogues to improve fracture healing. Eligible studies were prospective randomised controlled trials of adults with acute fractures treated with a PTH analogue. PTH improved functional outcomes but did not affect fracture healing rate or reduce pain.

Purpose

This meta-analysis evaluated the evidence of parathyroid hormone (PTH) analogues in fracture healing. The use of PTH analogues to prevent osteoporotic fractures is well investigated, and studies are emerging on extended indications. One such indication receiving increasing attention is the effect of PTH in fracture healing; however, the overall degree of efficacy remains inconclusive.

Methods

A systematic electronic database search of MEDLINE, EMBASE and the Cochrane Library was conducted for relevant articles in August 2019 with no date restrictions. Randomised controlled trials of adults with acute fractures treated with a PTH analogue were included. PTH was compared with a comparator intervention, placebo or no treatment.

Results

PTH analogue treatment improved functional outcomes in a range of fracture types but did not affect the fracture healing rate or reduce pain. Most trials included in this review were in elderly patients with osteoporosis. There was no evidence that PTH treatment caused harm or impeded fracture healing.

Conclusions

Meta-analysis of published data supports the use of PTH analogues to improve functional outcomes but not fracture healing rate or pain for different fracture types. The evidence for PTH analogue use in fracture healing is less clear in younger, non-osteoporotic patient populations. Trial design was heterogeneous and of limited quality, justifying further original trials.

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Data availability

This study used data already in the public domain, data collection tools will be made available on request to the corresponding author.

Notes

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    https://www.nice.org.uk/

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Acknowledgements

We would like to thank both Professor Lee Shepstone (Norwich Medical School) and Dr Andoni Toms (Norfolk and Norwich University Hospital), for their help with the statistical and imaging analysis respectively in this meta-analysis.

Funding

This research was funded as part of a Ministry of Defence, UK grant.

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Corresponding author

Correspondence to K. Eastman.

Ethics declarations

Conflicts of interest

Professor William Fraser has received unrestricted research grants, sat on advisory boards and given lectures on behalf of Eli Lilly, NPS and Nycomed. Dr Matt Gerlach, Dr Isabelle Piec, Prof Julie Greeves and Mrs Katharine Eastman have no conflicts of interest.

Ethics approval

This study was not a human or animal experiment so no ethical approval was required.

Consent to participate

This study used data already in the public domain, there was no requirement for consent to be taken.

Consent for publication

This study used data already in the public domain, there was no requirement for consent to be taken.

Code availability

Software used was Review Manager (RevMan) [Computer program]. Version 5.3. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2014.

RoB 2 tool [Computer program]. Sterne JAC, Savović J, Page MJ, Elbers RG, Blencowe NS, Boutron I, Cates CJ, Cheng H-Y, Corbett MS, Eldridge SM, Hernán MA, Hopewell S, Hróbjartsson A, Junqueira DR, Jüni P, Kirkham JJ, Lasserson T, Li T, McAleenan A, Reeves BC, Shepperd S, Shrier I, Stewart LA, Tilling K, White IR, Whiting PF, Higgins JPT. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ 2019; 366: l4898.

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Eastman, K., Gerlach, M., Piec, I. et al. Effectiveness of parathyroid hormone (PTH) analogues on fracture healing: a meta-analysis. Osteoporos Int (2021). https://doi.org/10.1007/s00198-021-05847-0

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Keywords

  • Fracture healing
  • Meta-analysis
  • Osteoporosis
  • Parathyroid hormone
  • Teriparatide