Parathyroid Hormone 1-34(Teriparatide) Treatment in Pelvic Insufficiency Fractures - A Report of Two Cases -
The patient was a 76 year old female and visited outpatient clinic due to the left hip pain that was occurred after a fall (slip down). Fractures in left pubic ramus were observed on simple radiograph at the admission and fractures in sacrum left side were found in bone single photon emission computed tomography (SPECT) and computed tomography (CT) scan (). In bone mineral density examination utilizing dual-energy X-ray absorptiometry (DXA; Prodigy Advance™, GE-Lunar Corp., Madison, WI, USA), osteoporosis was diagnosed with T-score -5.2 (L1-4) but the patient didn't have history of diagnosis and treatments in osteoporosis before the injury. Although teriparatide was only allowed for the treatment of osteoporosis in Korea, the patient was given 20 µg of teriparatide (1-34 PTH, Forsteo®) subcutaneously once a day in order to promote fracture healing as well as treat osteoporosis. Teriparatide was administered for 8 weeks. Bed rest and medication for pain relief was combined at the same time; tramadol 50 mg (Tridol®) was injected intravenously twice, morning and night, a day for seven days and transdermal fentanyl patch 12 µg/hr (Durogesic® DTrans®) was administered every 72 hours for 4 weeks. Pain visual analogue scale (VAS) was 7 at the time of admission and then decreased to 3 two weeks after the administration. The patient was able to move using a wheelchair a week after the injury and walked using a walker 10 days after the injury. Then, the patient was able to walk herself without pain six weeks after the injury. On simple radiograph a month after the injury, callus formation was observed in left pubic ramus and then it was even definitely denser on 3 months follow-up x-ray ().