Delay of consolidation and bisphosphonates: Two cases

Timing of the initiation of bisphosphonates after surgery for fracture healing: a systematic review and meta-analysis of randomized controlled trials

“…Furthermore, fracture recovery was more greatly affected by fracture stability provided by internal or external fixation than by the pharmacological effects of BPs. Despite some case reports suggesting a potential complication of fracture healing of BP therapy after long-term use [22][23][24], our study only included the participants who had not accepted BP therapy before surgery of fracture or had undergone a washout period. Early administration of BPs was associated with higher BMDs.…”

“…Animal studies have reported controversial results, with some articles reporting delays in fracture healing [11][12][13], no effect [14,15], or even enhanced fracture healing [16][17][18][19][20][21]. Some case reports suggest that a potential complication of long-term BP therapy may be a delay in fracture healing in humans [22][23][24]. A case control study reported that BP use in the post-fracture period was associated with an increased probability of nonunion (odds ratio [OR] 2.37, 95 % confidence interval [CI] 1.13 to 4.96) [25].…”

Early bisphosphonate therapy post proximal femoral fracture fixation does not impact fracture healing: a systematic review and meta‐analysis

“… BMD, bone mineral density; BMI, body mass index; DHS, dynamic hip screw; HHS, Harris hip score (score/100); IMN, intramedullary nail; MHHS, Modified Harris hip score (score/100); n/r, proportion not reported; OQOLS, osteoporosis quality of life scale; PFNA, Proximal femoral nail antirotation; RUSH, radiographic union score for hip 8–30 ; SF‐36, short form‐36 (0–100); VAS, visual analog scale. …”

“…However, there is concern regarding the theoretical risk of bisphosphonates on fracture healing because osteoclasts are implicated in both primary, direct bone healing and the remodelling of bony callus present in secondary bone healing. Early studies in both animal [9][10][11][12][13] and human [14][15][16][17][18][19] models reported mixed outcomes ranging from delayed to enhanced fracture healing. Several of these reports are on 'atypical' bisphosphonaterelated fractures, a cohort whose healing is now known to be significantly slower [20][21][22] and not reflective of 'normal' milieu.…”