A preliminary study from Hospital for Special Surgery, New York, shows an approved therapy for osteoporosis, Forteo (teriparatide), may speed healing and improve patient outcomes for those undergoing rotator cuff surgery.

“According to a previous study, only 69% of rotator cuff repairs were completely healed when evaluated 2 years after the surgery,” said senior author Scott Rodeo, MD, co-chief of the Sports Medicine and Shoulder Service at Hospital for Special Surgery. “Although not all of the patients with failed rotator cuff tendon healing had poor clinical outcomes, we wanted to look for ways to further improve patient outcomes.”

Forteo is a synthetic version of parathyroid hormone, which is the body’s primary regulator of calcium and phosphate levels in bone. Recently approved by the FDA, it is prescribed for osteoporosis, as it not only stimulates bone growth but it also slows the rate of bone loss.

“The healing process [of rotator cuff repair surgery] occurs from both the bone and the tendon, which is made up of collagen,” said lead author Carolyn Hettrich, MD, MPH, fifth-year resident in orthopedic surgery at Hospital for Special Surgery. “We knew the drug Forteo is osteogenic and can stimulate bone growth, but we found reports in the literature that it is also chondrogenic, so it can promote cartilage formation as well.”

The researchers hypothesized that because Forteo stimulated both bone and cartilage formation, it might enhance the healing process after rotator cuff surgery. Using a rat model, they performed the surgery and then gave some rats Forteo injections in amounts comparable to human doses.

At 2 weeks postsurgery, the repair was not as strong in the rats who received the Forteo; however, when the researchers looked at weeks 4 through 8, the tendon to bone interface in those rats appeared much more like normal tissue. Closer examination showed that not only had those rats that received Forteo produced more bone and cartilage cells, but the organization of the tissue was better and more closely resembled normal tissue. The tendon was also significantly stiffer, a sign of proper healing, at 8 weeks.

“The results are positive, but now we want to understand why at week 2 the tendon wasn’t healing as well,” Hettrich said. “Our next experiments will look to pinpoint these causes and determine the optimum delivery time of the drug after surgery.”

The researchers caution that it would be risky to use Forteo in patients undergoing rotator cuff surgery just yet as further studies are needed.

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