Osteoporosis can increase pathological fractures and approximately 8.9 million osteoporotic fractures occur each year worldwide. Decreased bone density is most commonly found in the pelvic bone and spine which can lead to osteoporosis in patients with osteopenia or risk factors for osteoporosis. In addition, osteoporosis can lead to impediments to fracture healing or other complications.
Bisphosphonate drugs can prevent bone mass loss by inhibiting resorption by osteoclasts and are frequently used anti-osteoporosis drugs. Studies have shown that bisphosphonates can down-regulate bone metabolism which can lead to low bone turnover. For fracture patients, the use of bisphosphonates can significantly reduce fracture recurrence rates. Available data suggests that all FDA-approved drugs for osteoporosis including bisphosphonates are safe to administer 1-2 weeks post-acute fracture. However, the role of bisphosphonate in fracture healing is controversial.
Therefore, a meta-analysis study was conducted on 16 studies involving 5,022 patients. The results showed that bisphosphonate had no significant effect on fracture healing time, but significantly increased bone mineral density (BMD) and prevented osteoporosis. In addition, bisphosphonate can inhibit bone resorption as well as bone formation markers, and cause low bone turnover compared to placebo.
It was concluded that bisphosphonate has no significant effect on fracture healing time, but can increase BMD and decrease markers of bone formation and resorption. Early use of bisphosphonate after injury in appropriate patients may be considered.
Image: Illustration (Source: rawpixel.com - Freepik)
Reference:
1. Gao Y, Liu X, Gu Y, Song D, Ding M, Liao L, et al. The effect of bisphosphonates on fracture healing time and changes in bone mass density: a meta-analysis. Front. Endocrinol.2021;12(688269).
2. Barton DW, Smith CT, Piple AS, Moskal SA, Carmouche JJ. Timing of bisphosphonate initiation after fracture: what does the data really say? Geriatr Orthop Surg Rehabil. 2020;11:2151459320980369.
