J Bone Metab.  2020 Feb;27(1):15-26. 10.11005/jbm.2020.27.1.15.

Effect of Osteoporosis Medication on Fracture Healing: An Evidence Based Review

Affiliations
  • 1Department of Orthopaedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. bakpaker@hanmail.net
  • 2Department of Orthopedic Surgery, Pusan National University Yangsan Hospital, Pusan National University College of Medicine, Yangsan, Korea.

Abstract

A systematic search was conducted and relevant studies that evaluated the influence of osteoporosis medications (bisphosphonates [BPs], denosumab, selective estrogen receptor modulators [SERMs], recombinant human parathyroid hormone teriparatide [TPTD], and strontium ranelate [SrR]) on wrist, hip, and spine fracture healing, were selected. BPs administration did not influence fracture healing and clinical outcomes after distal radius fracture (DRF). Similar results were observed in hip fracture, but evidence is lacking for spine fracture. Denosumab did not delay the non-vertebral fractures healing in one well-designed study. No studies evaluated the effect of SERMs on fracture healing in humans. One study reported shorter fracture healing times in TPTD treated DRF patients, which was not clinically meaningful. In hip fracture, recent studies reported better pain and functional outcomes in TPTD treated patients. However, in spine fracture, recent studies found no significant differences in fracture stability between TPTD treated patients and controls. Evidence is lacking for SrR, but it did not influence wrist fracture healing in one study. In comparisons between TPTD and BPs, fracture healing and physical scores were not significantly different in hip fracture by 1 study. In spine fracture, controversy exists for the role of each medication to the fracture stability, but several studies reported that fracture site pain was better in TPTD treated patients than BPs treated patients. Considering no clinical data of negative fracture healing of the antiresorptive medication and the danger of subsequent fracture after initial osteoporotic fracture, there is no evidence to delay initiation of osteoporosis medications after fracture.

Keyword

Denosumab; Diphosphonates; Osteopososis; Osteoporotic fractures; Teriparatide

MeSH Terms

Denosumab
Diphosphonates
Fracture Healing*
Hip
Humans
Osteoporosis*
Osteoporotic Fractures
Parathyroid Hormone
Radius Fractures
Selective Estrogen Receptor Modulators
Spine
Strontium
Teriparatide
Wrist
Denosumab
Diphosphonates
Parathyroid Hormone
Selective Estrogen Receptor Modulators
Strontium
Teriparatide
Full Text Links
  • JBM
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
    DB Error: unknown error