Assessment of Teriparatide’s Effect on Post-operative Functional Outcome and Fracture Healing

Introduction: Osteoporotic fractures represent a substantial clinical burden with compromised healing trajectories and elevated non-union risk. Teriparatide, a recombinant parathyroid hormone analog, demonstrates anabolic bone formation capacity through enhanced osteoblastic activity. However, optimal patient selection and treatment protocols remain inadequately defined. This retrospective comparative study investigated adjuvant teriparatide efficacy in enhancing post-operative fracture healing outcomes among patients undergoing open reduction internal fixation (ORIF) for osteoporotic fractures, with particular emphasis on identifying patient subpopulations demonstrating maximal therapeutic benefit. Materials and Methods: This study enrolled 120 patients aged 40-75 years with osteoporotic fractures requiring surgical fixation at a tertiary care teaching hospital from August 2020 through August 2024. Participants received either standard therapy (oral calcium and Vitamin D3) or adjuvant teriparatide therapy. Primary outcomes encompassed radiographic union rates, non-union and delayed union incidence, and complication profiles assessed at 3-month intervals throughout 9-month post-operative surveillance. Radiographic healing was independently evaluated by two fellowship-trained orthopedic radiologists employing validated criteria. Results: Baseline characteristics demonstrated statistical equivalence. All patients underwent ORIF using standard AO/Orthopaedic Trauma Association principles, with surgical approach and fixation method. Teriparatide therapy yielded statistically significant non-union reduction with 8 participants (13.33%) in standard therapy versus 1 participant (1.67%) in the teriparatide group, P = 0.0160, relative risk (RR) 0.125 with 95% confidence interval (CI) 0.016-0.973, representing 87.5% RR reduction. Delayed union was eliminated in teriparatide recipients with 8 participants (13.33%) versus 0 participants (0%), P = 0.0030. Pre-specified subgroup analysis revealed pronounced treatment effect modification in osteoporotic participants with treatment-by-osteoporosis interaction P < 0.0001, wherein 14 of 17 participants (82.35%) achieved late-phase healing between 6 and 9 months, yielding a number needed to treat of 1.2 patients with 95% CI 1.0-1.6. Safety profile remained acceptable with zero serious adverse events and 57 participants (95%) maintaining treatment adherence. Conclusion: Adjuvant teriparatide therapy demonstrates substantial efficacy preventing non-union and eliminating delayed union in osteoporotic fracture patients undergoing surgical fixation. However, paradoxical temporal healing patterns suggest teriparatide functions optimally as a targeted salvage intervention in delayed-healing fractures rather than a universal accelerator, emphasizing patient selection criticality for optimizing therapeutic yield.