Table 2.
Summary of Retrospective Cohorts of AFF Patients and Use of Teriparatide
| Reference | Total Cohort, n | Patients on TPT, n | Controls Without TPT, n | Fracture Type of TPT Usersa | Female, n (%) | Mean Age (years) | Country | AR Use | Mean Duration AR, (years; range) | Main Outcome |
|---|---|---|---|---|---|---|---|---|---|---|
| Cheung, 2013 | 22 | 22 | 0 | Incomplete: Surgical = 3 AFFs Conservative = 19 AFFs | 22 (100%) | 66 | Canada | Yes (100%) | 12 (3.4–28.7) | Of 19 incomplete AFFs without surgery, 2 healed, 5 were healing, 12 were stable after 2 years of TPT, but 4 patients developed new incomplete AFFs |
| Lee, 2013 | 51 | 19 | 32 | Incomplete: Surgical = 12 AFFs Conservative = 7 AFFs | 50 (98%) | 70.4 | South Korea | Yes (77%) | 4.5 | 7 patients on TPT and 19 patients without TPT required surgery; use of teriparatide did not significantly reduce the need for surgery (P = 0.210) |
| Lee, 2017 | 44 | 14 | 30 | Complete: n = 14 AFFs | 44 (100%) | 70.1 | South Korea | Yes (100%) | 5.1 | Time to healing was 4.9 months in TPT group, 6.6 months in non-TPT group, and 7.1 months in those continued on bisphosphonates |
| Miyakoshi, 2015 | 34 | NS (21 AFFs) | NS (24 AFFs) | Incomplete: Surgical = 5 AFFs Conservative = 5 AFFs Complete: n = 11 AFFs | 34 (100%) | 78.5 | Japan | Alendronate or risedronate (100%) | 4.4 (1–11.7) | Time to healing was significantly shorter for all surgically treated AFF in TPT group (5.4 vs 8.6 months) |
| Petraszko, 2016 | 7 | 6 | 1 | Incomplete: Conservative = 8 AFFs Surgical = 1 AFF | 7 (100%) | 70.7 | USA | Yes (100%) | 10.6 (7–15) | Fracture line disappeared in 2 of 6 AFFs with a visible line within 1 year of TPT |
| Saleh, 2012 | 10 | 9 | 1 | Incomplete: conservative = 13 AFFs | 10 (100%) | 66.8 | USA | Alendronate or risedronate (100%) | 10 (4–17) | 5 AFFs without line all healed, 7 of 8 AFFs with fracture line had surgery after 3 months of TPT |
| Sato, 2017 | 12 | 6 | 6 | Incomplete: conservative = 6 AFFs | 12 (100%) | 55.6 | Japan | Alendronate (100%) | 5.9 (3.1–9.3) | All AFFs on continued bisphosphonates deteriorated; 1 AFF progressed to complete fracture after 8 months of TPT |
| Takakubo, 2017 | 8 | 4 | 4 | NS surgical = 5 AFFs | 8 (100%) | 54.9 | Japan | Alendronate, risedronate, minodronate (100%) | 4.3 (2–10) | Time to healing was 11.5 months in 5 AFFs on TPT and 13.3 months in 6 AFFs without TPT, but 1 AFF was not healed after 1 year and lost to follow- up in the TPT group |
| Yeh, 2017 | 13 | NS (8 AFFs) | NS (8 AFFs) | Complete: n = 8 AFFs | 13 (100%) | 70.2 | Taiwan | Alendronate (100%) | 4.0 (2.5–6) | Time to healing was 4.4 months in the TPT group vs 6.2 months in the non- TPT group |
Percentage of women, mean age, antiresorptive use and mean duration of antiresorptive treatment were based on the whole cohort, including controls.
Abbreviations: AFF, atypical femur fracture; AR, antiresorptive; NS, not stated; TPT, teriparatide.
aWhen the number of AFFs is not stated in the article, the number of patients is given.