Treatment of Tibial Stress Fracture in Elite College Athlete using Teriparatide (Forteo)

An elite 21-year-old male college basketball player developed a Fredericson Grade 4A stress fracture to the right tibia. His symptoms did not improve despite rest and he was unable to participate in activity. The patient's history, physical examination, and imaging, including right tibial radiographs and MRI, were indicative of a stress fracture to the tibial shaft. He was therefore recommended nonoperative management, consisting of a tall boot for two weeks, rest from activity for 4-6 weeks, and daily Teriparatide (Forteo) injections for two months. The athlete was able to return to the court after seven weeks of this non-operative treatment plan without physical limitations or pain, while logging the second highest total minutes played on the entire team following his return. This case report reviews the evaluation and treatment of stress fractures in athletes and the efficacy of using Teriparatide to expedite return to asymptomatic play.