Osteoporosis Medications and Fracture Healing

Little clinical guidance exists on how soon after a fracture occurs that osteoporosis medications should be prescribed.

A multidisciplinary panel of experts recently gathered to evaluate osteoporosis medications in patients who experienced a fracture and the possible role of medication in fracture healing.

Researchers studied existing literature and discussed the effect of osteoporosis medication on fracture healing, risk factors for delayed fracture healing, clinical and research goals, guidelines for future trial design, and clinical scenarios of fracture healing, according to a report published by Osteoporosis International.

"There has been little data on the role of osteoporosis medications in fracture healing and as a result there is little consensus or clinical guidance on how soon after fracture medications should be prescribed,” said study lead author Stuart Silverman, MD, FACP, FACR. “We hope that this consensus report will help to set the scene for both improved patient care and good clinical study design for future research in this area."

Researchers agreed that preventing delayed fractures should be a goal of healthcare providers, while patients at risk should be identified early, in order to consider intervention.

There was no evidence in delayed healing when injectable bisphosphonates were given within 2 weeks after the fracture, yet the panel agreed that antiresorptives, such as bisphosphonates may have a low risk of delaying healing.

Anabolic agents like teriparatide potentially have a beneficial on fracture healing, since it enhances osteoblastic bone formation, according to the report.

The panel also outlined future trial design and guidelines for the role of osteoporosis medications on fracture healing.

Overall, the researchers agreed there was no negative effect from osteoporosis medications on fracture healing and the medication should be started soon after a vertebral or nonvertebral fracture occurs.

After an atypical femur fractures, the panel recommended stopping bisphosphonate therapy. Anabolic agents could potentially improve healing.

"If appropriately treated, patients who have suffered a first fracture can considerably reduce their risk of future debilitating fractures. This consensus report provides clinicians with an excellent point of reference on the effects of osteoporosis medications on fracture healing, including when making treatment decisions in regard to patients who are experiencing delayed fracture healing. It is also a valuable blueprint for future clinical studies on the role of osteoporosis medication and fracture healing,” concluded researcher Cyrus Cooper OBE, MA, DM, FRCP, FFPH, FMedSci.