Table 4.
Radiological Healing of AFF After Teriparatide: Pooled Data
| Incomplete AFF (conservative) | Incomplete AFF (surgical) | Complete AFF | ||
|---|---|---|---|---|
| Fracture Healing and Teriparatide Use; n = 140 Patients | TPT | TPT | TPT | No TPT |
| Number of AFFs (total 165) | 30 | 10 | 58 | 67 |
| Healing ≤ 6 months of TPT | 13 (43%) | 9 (90%) | 44 (76%) | 34 (51%) |
| Healing 6–12 months of TPT | 4 (13%) | 1 (10%) | 9 (16%) | 29 (43%) |
| No union achieved at 12 months | 9 (30%) | - | 5 (9%) | 4 (6%) |
| Progression to complete AFF | 4 (13%) | NA | NA | NA |
Abbreviations: AFF, atypical femur fracture; NA, not applicable; TPT, teriparatide.
Five AFFs that underwent surgical procedures from Takakubo et al were categorized as complete fractures. In the study by Miyakoshi et al, 1 nonoperated incomplete AFF and 1 surgically treated incomplete AFF on teriparatide and 8 complete AFFs without teriparatide were labeled as healed by the authors between 6 and 24 months. These fractures were categorized as “healing at 12 months.” From the study by Sato et al, only progression to complete AFF in 1 patient on teriparatide and 1 without teriparatide could be established, while for the other 19 incomplete AFFs, the fracture healing was not specified.
Excluded: Patients (n = 7) without fracture consolidation after ≤ 6 months of teriparatide use (18, 50, 51) (n = 3), (20) (n = 3 with surgery after 3 months), (48) (n = 1, case no. 3), fracture healing could not be assessed with certainty (52, 53), duration of fracture healing or fracture type were not reported (14, 19, 27, 28).