The Role of Recombinant Parathormone derivative in Bone healing. Making the Unfavorable, Favorable - A Systematic Review

Background: Teriparatide is a recombinant parathormone derivative encompassing the first 1-34 amino acids off PTH, which is said to contain potent anabolic capability. It is said to induce osteoblastogenesis thereby placing an essential role in bone healing. The aim of this systematic review is to evaluate the best available evidence from randomized controlled trials analyzing the effectiveness of teriparatide on bone regeneration and healing in osteoporotic patients and patients with fractures. Aim: This systematic review aims to assess whether Teriparatide enhances bone regeneration and healing in terms of improving clinical, radiographic, histologic parameters and Biomarkers of Bone formation and resorption. Materials and Methodology: A comprehensive search was done in databases such as ‘PubMed’, ‘Google Scholar and ‘Cochrane’ databases based on pre-determined eligibility criteria. Randomized control trials assessing the effectiveness of Teriparatide in Bone healing in fractures as well as osteoporosis were selected after thorough screening. Results: The selected 13 studies compared teriparatide to either placebo or another anti-resorptive drug. Out of the 13, 8 studies were done to evaluate the improvement and healing of bone in Osteoporotic patients whereas 5 studies were done on improvement in fracture healing. The studies evaluated outcome parameters such as Clinical and Radiological improvement, Biomarkers of Bone resorption and formation and Safety.6 studies assessed clinical parameters, 12 studies assessed radiological parameters, 7 studies assessed biomarkers, 11 studies assessed safety parameters by means of occurrence of any adverse effects. All the 8 studies done on osteoporotic patients showed a good improvement. Of the 5 studies on fracture healing, only 2 studies showed beneficial effects while the other 3 did not show any benefits. Conclusion: Teriparatide could have beneficial effects in bone healing in osteoporotic patients and is well tolerated. However, the results are inconclusive whether they have beneficial effects in treating fractures. More Homogenous Randomized control trials are required to ascertain whether teriparatide could improve bone healing.