| Objective: To systematically review the efficacy and safety of rhPTH for healing in osteoporotic fracture.Methods: We performed a literature search in CBM,CNKI,Wan-fang database,VIP,PubMed,EMBASE,Cochrane Library,Web of Science in December 2017 for randomized controlled trials(RCTs)which concerned the treatment of rhPTH for healing in the osteoporotic fracture.Document Retrieval language is in Chinese and English.The bias risk of included studies were evaluated according to the Cochrane handbook.Results: 5 studies including 573 patients were identified,81 males(15.1%)and 456females(84.9%).The fracture sites were distal humerus,pelvis,pertrochanteric hip,femoral neck and proximal humerus,all of which were nonvertebral fractures.1.The results of distal radius fracture showed that compared with placebo,the healing time of teriparatide 20ug/d was significantly shortened(7.4 weeks vs.9.1 weeks),has a statistically significant difference(P=0.006).Fracture healing time was shortened at40ug/d(8.8 weeks vs.9.1 weeks),but the difference was not statistically significant(P=0.523);between the two experimental groups,there was a shorter time for teriparatide20ug/d in fracture healing(7.4 weeks vs.8.8 weeks);but the difference was not statistically significant(P = 0.053).Compared with the placebo group,there was no significant decrease in the PRWE pain score between the teriparatide 40 ?g/d group and the teriparatide 20 ?g/d group [-24.6 vs.-28.4 vs.-26.1(17 weeks)].The difference was not statistically significant(P>0.05).The grip strength of teriparatide 20 ?g/d and teriparatide40 ?g/d did not increase significantly [17.6 vs.17.6 vs.17.8(17 weeks)],the difference was not statistically significant(P> 0.05).2.The results of pelvic fracture showed that compared with the control group,the healing time of PTH1-84(100ug/d)was significantly shortened(7.8 weeks vs.12.6 weeks),and the fracture healing rate was significantly improved(100% vs.9.1%),the VAS pain score was significantly decreased(3.2 vs.6.5),and the TUG test completion time was significantly shorter(22.9 seconds vs.4.3 seconds),and the difference was statisticallysignificant(P<0.001).3.The results of the pertrochanteric hip fracture showed that there was no significant difference in fracture healing time and healing rate of teriparatide 20ug/d compared to risedronate 35mg/week(86 days vs.84 days,P=0.547;100% vs.98.4%,P=1.000),but the VAS pain score was significantly decreased,the difference between groups is 10.9,with a statistically significant difference(P=0.032),and the TUG test completion time was significantly shorter,the difference between groups is-3.1,with a statistically significant difference(P=0.021).4.The study of femoral neck fractures showed that compared with placebo,the healing rate of teriparatide 20ug/d fracture was slightly lower(73% vs.75%),but the difference was not statistically significant(P=0.692).The proportion of patients with a 7-point score was slightly higher(92% vs.91%),but the difference was not statistically significant(P=0.681).The proportion of patients with accelerated walking was significantly higher(89% vs.73%),with a statistically significant difference(P=0.021).5.The results of the proximal humeral fracture showed that under the assumption that teriparatide promotes osteoporotic fracture healing,two radiologists judge the patient's treatment through fracture healing.Among 31 patients,a total of 21 patients were correctly judged in the treatment,and the correct rate was less than 80%,the difference was not statistically significant.Compared with the control group,the VAS pain score at the 7th week of teriparatide 20ug/d decreased(30 vs.38.5),but the difference was not statistically significant(P=0.5);the DASH score decreased(28 vs.42),but the difference was not statistically significant(P=0.2).6.In terms of adverse events,compared with the control group in the 5 studies,there was no significant increase in the incidence of serious adverse events in the recombinant human parathyroid hormone group(P>0.05).Conclusion: Recombinant human parathyroid hormone may be a safe and effective drug for promoting the healing of osteoporotic fractures. |
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