Teriparatide [PTH (1-34)] is a genetically engineered analog of human 
parathyroid hormone that acts as an anabolic drug by increasing activity in both 
osteoblasts and osteoclasts. Intermittent (once-daily) doses of teriparatide 
seem to stimulate osteoblast activity and therefore result in a net increase of 
bone formation. It is recommended for use in post-menopausal women (PMW), men 
with hypogonadal osteoporosis, as well as men and women with 
glucocorticoid-induced osteoporosis. In vivo studies have generated important 
findings regarding teriparatide's role in the enhancement of fracture healing. 
The intention of this article is to review the clinical findings of teriparatide 
to stimulate fracture healing. The drug was shown in a prospective randomized, 
double blind study to achieve earlier radiographic cortical bridging of three of 
four cortices (7.4 weeks) compared to patients who were assigned to the placebo 
group (9.1 weeks). Another study compared mean time for healing and functional 
outcome in two groups of elderly women who had suffered osteoporotic pelvic 
fractures: one group received daily 100 μg parathyroid hormone (1-84) 
injections, while the other group received no treatment. Patients who received 
the PTH (1-84) injections accelerated radiographic and clinical fracture healing 
(7.8 weeks) when compared to patients who received no treatment (12.6 weeks, 
p<0.001). Numerous case series state the safety and potential benefits of 
teriparatide use in patients recovering from fractures. In the following 
scenarios, teriparatide might be considered in patients with osteoporosis and a 
fracture: (1) patients with severe osteoporosis with use of bisphosphonates for 
a number of years with a fracture not expected to predictably unite, e.g. 
atypical femur fracture or open tibia fracture, (2) in cases where an 
osteoporotic patient has failed fracture healing and is considering surgical 
treatment e.g. non-union surgery. It seems prudent to reevaluate these patients 
frequently and reconsider which drug class of osteoporotic drug is best for the 
patient. Finally, it must be stressed that we do not recommend teriparatide in 
osteoporotic patients that may be well treated with bisphosphonates and a 
fracture is expected to heal uneventfully, nor when patients with metabolically 
normal bone have a fracture.