Would you start anabolic agents for osteoporotic hip fracture healing?

There are two relatively well-done trials for tptd for fracture healing of the proximal femur. There was a Phase 3 trial for femoral neck fractures. The FDA made it quite complicated and demanded 2 separate trials of 1,200 patients each. The trials were 3 years in duration with many difficult outcomes. Recruitment stalled at about a total of 150, and the sponsors stopped the study due to futility. The enrolled patients were analyzed, and there was no difference in outcomes between the placebo and tptd. However, the number of patients was too small to reach the power needed to demonstrate a difference.

A study was done in patients with intertrochanteric fractures. The primary outcome was BMD, but secondary outcomes focused on fracture healing and recovery. While it is difficult to determine fracture healing with this type of hip fractures, important outcomes like times up and go were significantly better in the tptd arm, suggesting tptd may enhance recovery in intertrochanteric femur fractures.

There have been considerable reports of enhanced healing in atypical femur fractures, but no large clinical trials.

If a patient has high risk for fracture, (almost all elderly hip fracture patients), we can consider TPTD or abaloparatide to treat OSTEOPOROSIS. If there is enhanced fracture healing, it is a nice bonus!

This would be a reasonable therapy. I know of no controlled studies.

This is a broad question and does not have a simplified answer. It depends on the age of the patient, prior treatment history and also the bone density.