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Abstract
Background and purpose Intermittent administration of parathyroid hormone (PTH) has an anabolic effect on bone, as confirmed in human osteoporosis studies, distraction osteogenesis, and fracture healing. PTH in rat models leads to improved fixation of implants in low-density bone or screw insertion transcortically.
Material and methods We examined the effect of human PTH (1–34) on the cancellous osseointegration of unloaded implants inserted press-fit in intact bone of higher animal species. 20 dogs were randomized to treatment with human PTH (1–34), 5 μg/kg/day subcutaneously, or placebo for 4 weeks starting on the day after insertion of a cylindrical porous coated plasma-sprayed titanium alloy implant in the proximal metaphyseal cancellous bone of tibia. Osseointegration was evaluated by histomorphometry and fixation by push-out test to failure.
Results Surface fraction of woven bone at the implant interface was statistically significantly higher in the PTH group by 1.4 fold with (median (interquartile range) 15% (13–18)) in the PTH group and 11% (7–13) in control. The fraction of lamellar bone was unaltered. No significant difference in bone or fibrous tissue was observed in the circumferential regions of 0–500, 500–1,000, and 1,000–2,000 μm around the implant. Mechanically, the implants treated with PTH showed no significant differences in total energy absorption, maximum shear stiffness, or maximum shear strength.
Interpretation Intermittent treatment with PTH (1–34) improved
histological osseointegration of a prosthesis inserted press-fit at surgery in cancellous bone, with no additional improvement of the initial mechanical fixation at this time point.
HD: the main researcher, who prepared the protocol, performed surgery, collected and analyzed data, and wrote the article. BE, TTA: reviewed the protocol and reviewed the data and the manuscript. AL: reviewed the protocol and the manuscript. JEB: reviewed the protocol, performed surgery, and reviewed the manuscript. KS: reviewed the protocol, performed surgery, and reviewed the article.
We thank the Danielsen Foundation, the Erik Horslev Foundation, and the Velux Foundation for financial support. The work was also supported by grant AR42051 from the NIH.
No competing interests declared.