Case Report
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Jan 18, 2017; 8(1): 82-86
Published online Jan 18, 2017. doi: 10.5312/wjo.v8.i1.82
Teriparatide anabolic therapy as potential treatment of type II dens non-union fractures
Enrico Pola, Virginia Pambianco, Debora Colangelo, Virginia M Formica, Giovanni Autore, Luigi A Nasto
Enrico Pola, Virginia Pambianco, Debora Colangelo, Virginia M Formica, Giovanni Autore, Spinal Unit, Department of Orthopaedics and Traumatology, “A. Gemelli” University Hospital, Catholic University of Rome, 00168 Rome, Italy
Luigi A Nasto, Centre for Spine Studies and Surgery, Queen’s Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham NG7 2UH, United Kingdom
Author contributions: Pola E and Pambianco V contributed equally to this work; Pola E, Pambianco V and Nasto LA designed the research and analysed the data; Pola E, Formica VM, Autore G and Nasto LA conceived the study and participated in its coordination; Pola E, Pambianco V, Colangelo D and Nasto LA wrote the paper; all authors had read and approved the final manuscript.
Institutional review board statement: This case report was exempt from the Institutional Review Board approval as per Catholic University of Rome guidelines.
Informed consent statement: The patient involved in this study gave her oral informed consent to be included in this study.
Conflict-of-interest statement: The authors have no conflicts of interests to disclose about this study.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Enrico Pola, MD, PhD, Assistant Professor, Spinal Unit, Department of Orthopaedic and Traumatology, “A. Gemelli” University Hospital, Catholic University of Rome, L.go Agostino Gemelli 8, 00168 Rome, Italy.
Telephone: +39-340-2636062 Fax: +39-06-3051161
Received: March 31, 2016
Peer-review started: April 1, 2016
First decision: May 17, 2016
Revised: June 15, 2016
Accepted: July 14, 2016
Article in press: July 18, 2016
Published online: January 18, 2017

Odontoid fractures account for 5% to 15% of all cervical spine injuries and 1% to 2% of all spine fractures. Type II fractures are the most common fracture pattern in elderly patients. Treatment (rigid and non-rigid immobilization, anterior screw fixation of the odontoid and posterior C1-C2 fusion) remains controversial and represents a unique challenge for the treating surgeon. The aims of treatment in the elderly is to quickly restore pre-injury function while decreasing morbidity and mortality associated with inactivity, immobilization with rigid collar and prolonged hospitalization. Conservative treatment of type II odontoid fractures is associated with relatively high rates of non-union and in a few cases delayed instability. Options for treatment of symptomatic non-unions include surgical fixation or prolonged rigid immobilization. In this report we present the case of a 73-year-old woman with post-traumatic odontoid non-union successfully treated with Teriparatide systemic anabolic therapy. Complete fusion and resolution of the symptoms was achieved 12 wk after the onset of the treatment. Several animal and clinical studies have confirmed the potential role of Teriparatide in enhancing fracture healing. Our case suggests that Teriparatide may have a role in improving fusion rates of C2 fractures in elderly patients.

Keywords: Type II odontoid fractures, Non-union, Anabolic therapy, Teriparatide, Fracture healing

Core tip: Odontoid fractures are common in elderly patients and treatment of these injuries remains challenging. Conservative management consists of rigid immobilization with collar or Halo vest. Delayed union or non-union is a common outcome in patients treated conservatively. For a symptomatic non-union, surgery may be the only option. In this case report we discuss the case of a patient with an odontoid fracture non-union successfully treated with systemic anabolic Teriparatide therapy. A complete fusion was achieved after 12 wk of treatment. Teriparatide therapy may have a role in fostering fusion of C2 fractures in elderly patients.