Parathyroid Hormone in the Management of Pelvic Fragility Fractures: A Systematic Review and Meta-Analysis
Abstract
1. Introduction
2. Materials and Methods
2.1. Eligibility Criteria
2.2. Search Strategy
2.3. Selection Process and Data Extraction
2.4. Outcome Measures
2.5. Risk of Bias and Quality Assessment
2.6. Statistical Analysis
2.7. Funding and Ethical Approval
3. Results
3.1. Study Characteristics
3.2. Clinical Outcomes
3.3. Complications and Adverse Events
3.4. Risk of Bias and Quality Assessment
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Abbreviations
| PTH | Parathyroid hormone |
| FFP | Fragility fracture of the pelvis |
| VAS | Visual analogue scale |
| MCID | Minimum clinically important difference |
References
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| Study ID | Country | Patients (n=) | Sex | Follow-Up (Months) | Design | Inclusion Criteria | PTH Treatment Protocol |
|---|---|---|---|---|---|---|---|
| Yang et al., 2023 [37] | Taiwan | 27 | Female only | 6 | Retrospective observational study | All female patients diagnosed with sacral insufficiency fractures between 2011 and 2021 | 20 μg/day for 6 months |
| Nieves et al., 2022 [36] | USA | 33 | Both | 12 | Randomised parallel-design phase 2 study (double-blind) | All patients > 50 years; acute fractures with minimal trauma presenting within 1 month of symptoms | 20 μg/day for 3 months |
| Na et al., 2017 [35] | Korea | 15 | Both | 12–18 | Retrospective observational study | Patients attending the hospital due to difficulty in ambulation caused by pelvic pain despite no or minor trauma between April 2011 and March 2014 | 20 μg/day “until fracture healing” |
| Kasukawa et al., 2017 [34] | Japan | 7 | Female only | 6–24 | Retrospective observational study | Patients with osteoporosis and sacral insufficiency fractures | 20 μg/day (5 patients) OR 56.5 μg/week (2 patients) for 6–12 months |
| Yoo et al., 2017 [38] | Korea | 41 | Both | 12 | Retrospective case-controlled study | Consecutive patients > 50 years, no signs of infection, never had radiation therapy, available for follow-up >1 year, and confirmed sacral insufficiency fractures on MRI/bone scan | 20 μg/day for 3–11 months |
| Peichl et al., 2011 [26] | Austria | 65 | Female only | 24 | Randomised controlled trial | Female patients, unilateral pelvic fracture, age > 70 years, and osteoporosis with T-score < −2.5 | 100 μg/day for 24 months |
| Study ID | Group (n=) | Admission VAS (cm) | Final VAS (cm) | Time at Final VAS | Radiographic Healing Criteria | Radiographic Healing Outcomes | Complications |
|---|---|---|---|---|---|---|---|
| Yang et al., 2023 [37] | PTH (14) | 8.0 ± 1.0 | 0.6 ± 0.8 | 24 weeks | Presence of callus or sclerosis at the fracture site on AP and lateral radiographs at 12 weeks | 6/14 callus 6/14 sclerosis | None |
| Sacroplasty (13) | 7.7 ± 0.8 | 2.7 ± 1.4 | 6/13 callus 1/13 sclerosis | ||||
| Nieves et al., 2022 [36] | PTH (18) | - | - | - | CT-modified version of the RUST scoring index at 12 weeks. “Healed” is defined as the bridging of 3 or 4 cortices | 50% healed | 8 adverse events (4 in each group) Not believed to be related to study medication |
| Placebo (15) | - | - | - | 53% healed | |||
| Na et al., 2017 [35] | PTH (5) | 7.2 | 3.2 | Not stated | Continuity of cortical bone on CT scan | 21.6 weeks to union (18–27) | Not stated |
| Conservative (10) | 7.44 | 3.67 | 30 weeks to union (22–34) | ||||
| Kasukawa et al., 2017 [34] | PTH (7) | 8.74 ± 1.1 | 1.29 ± 1.49 | 24 weeks | Not stated | 100% union or sclerosis seen on CT at 24 weeks | Not stated |
| Yoo et al., 2017 [38] | PTH (21) | 6.9 ± 1.5 | 3.4 ± 1.8 | 8 weeks | Cortical bridging on plain radiograph at 8 weeks | 100% healed | Not stated |
| Control (20) | 6.5 ± 2.5 | 4.8 ± 1.8 | 10% healed | ||||
| Peichl et al., 2011 [26] | PTH (21) | 7.6 ± 1.1 | 3.2 ± 1.0 | 8 weeks | Cortical bridging on CT at 8 weeks | 100% healed | None |
| Control (44) | 7.7 ± 1.1 | 6.5 ± 0.9 | 9.1% healed |
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Crooks, S.A.; Kuršumović, K.; Lewis, T.L.; Kanakaris, N.K. Parathyroid Hormone in the Management of Pelvic Fragility Fractures: A Systematic Review and Meta-Analysis. J. Clin. Med. 2026, 15, 1199. https://doi.org/10.3390/jcm15031199
Crooks SA, Kuršumović K, Lewis TL, Kanakaris NK. Parathyroid Hormone in the Management of Pelvic Fragility Fractures: A Systematic Review and Meta-Analysis. Journal of Clinical Medicine. 2026; 15(3):1199. https://doi.org/10.3390/jcm15031199
Chicago/Turabian StyleCrooks, Sophie A., Kenan Kuršumović, Thomas L. Lewis, and Nikolaos K. Kanakaris. 2026. "Parathyroid Hormone in the Management of Pelvic Fragility Fractures: A Systematic Review and Meta-Analysis" Journal of Clinical Medicine 15, no. 3: 1199. https://doi.org/10.3390/jcm15031199
APA StyleCrooks, S. A., Kuršumović, K., Lewis, T. L., & Kanakaris, N. K. (2026). Parathyroid Hormone in the Management of Pelvic Fragility Fractures: A Systematic Review and Meta-Analysis. Journal of Clinical Medicine, 15(3), 1199. https://doi.org/10.3390/jcm15031199

