Hip Pelvis.  2019 Jun;31(2):75-81. 10.5371/hp.2019.31.2.75.

Effect of Preoperative Bisphosphonate Treatment on Fracture Healing after Internal Fixation Treatment of Intertrochanteric Femoral Fractures

• Lim EJ
• Kim JT
• Kim CH
• Kim JW
• Chang JS
• Yoon PW

• KMID: 2448025
• DOI: http://doi.org/10.5371/hp.2019.31.2.75

Abstract

PURPOSE
There are concerns that administration of bisphosphonate (BP) can substantially suppress bone turnover, potentially interfering with fracture healing. We investigated the effects of preoperative BP administration before internal fixation of intertrochanteric femoral fractures using fracture healing and clinical outcomes.
MATERIALS AND METHODS
We retrospectively analyzed data from 130 patients who underwent internal fixation for osteoporotic intertrochanteric femoral fractures between March 2012 and July 2016. Patients previously treated with BPs for at least 3 months (BP group; n=29) were compared with the remaining patients (BP-naïve group; n=101). Radiographs were used to assess and compare fracture healing 3 months and 1 year postsurgery. The primary clinical outcome measure assessed was change in Koval score.
RESULTS
Fracture union at 3 months after surgery was verified in 72.4% of patients (21/29) in the BP group and 90.1% of patients (91/101) in the BP-naïve group (P=0.027). Fracture union at 1 year postsurgery (BP group, 93.1% [27/29] vs. BP-naïve group, 97.0% [98/101], P=0.310) and change in Koval score (1.1 vs. 1.0, P=0.694) were not significantly different between the groups. Multivariable logistic regression analysis revealed that a history of BP administration was associated with an increased risk of delayed union at 3 months postsurgery (P=0.014).
CONCLUSION
Preoperative administration of BP was associated with a decreased fracture healing rate 3 months after internal fixation, compared with BP-naïve patients. Therefore, patients previously treated with a BP should be carefully allowed to wean off walking aids and transition to full weight-bearing in the early postoperative period.

Keyword

Bisphosphonates; Hip fractures; Fracture healing; Nonunion; Osteoporosis

MeSH Terms

Bone Remodeling
Diphosphonates
Femoral Fractures*
Fracture Healing*
Hip Fractures
Humans
Logistic Models
Osteoporosis
Outcome Assessment (Health Care)
Postoperative Period
Retrospective Studies
Walking
Weight-Bearing
Diphosphonates

Figure

• 

  Fig. 1 Radiographs of an 80 year-old female patient previously treated with bisphosphonates for 22 months. (A) There was minimal callus formation and the fracture line remains visible at three months postsurgery. (B) Fracture union was confirmed on radiographs at six months postsurgery.

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