Review Article

Teriparatide and Atrophic Nonunion

Konstantinos Varvarousis^1,2, Christos Zafeiris²

1. Department of orthopaedics, General Hospital “Asklepieio Voulas”, Athens, Greece
2. Postgraduate Program “Metabolic Bone Diseases”, National and Kapodistrian University of Athens, Medical School, Athens, Greece

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Keywords: Atrophic nonunion, Bone Regeneration, Fracture Healing, Parathyroid Hormone, Teriparatide

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Abstract

Fracture healing is a complex biological process orchestrated by a delicate interplay of cellular and molecular mechanisms. While the majority of fractures heal spontaneously with appropriate treatment, challenging cases, such as atrophic nonunion, may require adjunctive therapies to achieve successful bone regeneration. In recent years, teriparatide has gained attention as a promising bone-forming agent with the potential to enhance fracture healing and improve clinical outcomes. Preclinical studies using animal models of bone injury have provided evidence supporting the efficacy of teriparatide in promoting fracture healing and resolving nonunion. Histological and radiological findings show that teriparatide enhances callus formation, accelerates bone remodeling, improves biomechanical properties, and reduces the incidence of healing complications. These preclinical results highlight the potential of teriparatide as a therapeutic agent for managing atrophic nonunion in clinical practice. However, further research is necessary to address the limitations of current studies and to establish evidence-based guidelines for the use of teriparatide in nonunion management.

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