The Use of Teriparatide as an Adjunctive Therapy for the Treatment of Jones Fractures

Inclusion Criteria:

- Patients who are at least 18 years of age and who have closed epiphyses.

- Patients of both genders and all races.

- Patients with Jones fractures of the fifth metatarsal less than 2 weeks prior to
presenting for clinical evaluation.

- Patients with a history of an acute injury and an acute Jones fracture defined by
Torg et al as a fracture line with sharp margins without widening, absence of
intramedullary sclerosis, and minimal or no cortical hypertrophy or evidence of
periosteal changes due to chronic stress.

- Patients with either no prodromal symptoms or prodromal symptoms present less than 2
weeks.

- Patients with a baseline visual analog scale (VAS) pain score ≤ 20 (100mm scale) for
the fifth metatarsal, with the foot at rest and not bearing weight.

- Patients who are in good general health and who have physical examinations that
either are within normal limits or are clinically non-significant as determined by
the investigator.

- Patients with laboratory evaluations that either are within normal limits or are
clinically non-significant as determined by the investigator.

- Patients who have voluntarily signed informed consent forms, including HIPAA
Authorization.

Exclusion Criteria:

- Patients who are younger than 18 years of age or patients who are 18 years of age or
older with open epiphyses.

- Patients with Jones fractures of the fifth metatarsal greater than 2 weeks prior to
presenting for clinical evaluation.

- Patients with tuberosity avulsion fractures or fifth metatarsal shaft fractures.

- Patients with prior fifth metatarsal fracture(s).

- Patients with prodromal symptoms present for more than 2 weeks.

- Patients with a nonunion or delayed union as defined by the radiographic criteria
described by Torg et al.

- Patients who are allergic to any of the individual active ingredients in teriparatide
or related compounds.

- Patients with chronic rheumatologic disease, ankylosing spondylitis or other
inflammatory arthropathy.

- Patients with associated injuries considered by the investigator as to likely
interfere with evaluation of the study drug.

- Patients with a present condition or history of any clinically significant
gastrointestinal, cardiovascular, hepatic, renal, hematologic, endocrine, neurologic,
psychiatric, connective tissue, respiratory or other medical disorders.

- Patients with Worker's Compensation claim(s) under dispute or mediation.

- Patients with history of drug or alcohol abuse.

- Patients who are pregnant or lactating.

- Patients who are considered by the investigator for any reason to be an unsuitable
candidate for receipt of the study drug.

- Patients who are unwilling or unable to follow the follow-up evaluation schedules.

- Patients who refuse to voluntarily sign the informed consent form.