Effect of teriparatide on improving fracture union in osteoporotic intertrochanteric fractures: A systematic review and meta-analysis

BACKGROUND Intertrochanteric or pertrochanteric fractures are common among the elderly population. They are primarily treated by internal fixation. Malunion, delayed union, and implant-related complications are often seen in this population due to osteoporosis, which leads to inadequate bone stock and delayed healing of bone. Teriparatide is an established first-line anabolic treatment for osteoporosis that increases bone turnover and promotes new bone formation. Recent papers have shown its role in fracture union in which it enhanced the callus formation and bridged the fractured ends of the bones. AIM To determine the effect of subcutaneous injection of teriparatide on osteoporotic intertrochanteric fractures. METHODS We searched PubMed, EMBASE, Scopus, and Cochrane Library for English language articles that were published by June 3, 2025. We selected articles that compared the use of teriparatide injection with either no injection or placebo in patients with osteoporosis who experienced an intertrochanteric fracture that was treated with internal fixation. Relevant data, including union time (primary outcome variable) and other radiological and functional outcome parameters, were extracted from the included studies. The web version of Cochrane’s Review Manager was used for meta-analysis. RESULTS Six studies (four randomized controlled trials and two non-randomized studies) met the inclusion criteria for this systematic review. A total of 393 patients [teriparatide (n = 175) and control (n = 218)] were included in the studies. Data from five of these studies were combined, and the pooled meta-analysis of the fracture union time [teriparatide (n = 155) and control (n = 198)] showed a significant difference in favor of the teriparatide group (standardized mean difference = -0.77, 95% confidence interval: -0.99 to -0.55, P < 0.00001). Other radiological parameters like varus collapse and incidence of complications were decreased in the teriparatide group. Functional outcomes were better in the early follow-up of patients who received teriparatide. However, the follow-up outcomes were similar in the long term for both groups. CONCLUSION The meta-analysis showed that teriparatide reduced union time, varus collapse, and complications in osteoporotic intertrochanteric fractures. However, these findings should be interpreted cautiously due to limited evidence and small sample size.