Delayed/non‐union of upper limb fractures with bisphosphonates: systematic review and recommendations

Ng, Andrew; Yue, Brian Yin Ting; Joseph, Samuel; Richardson, Martin

doi:10.1111/ans.12536

Cited by 19 publications

(16 citation statements)

References 36 publications

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“…Conversely, fracture healing in patients already on BP at the time of fracture was reported to be slightly delayed, but there was no difference in non-union incidence. [30] Similarly, Rozental and colleagues report that BP use prior to distal radius fracture resulted in <1 week of delay in healing, but in a separate study, the early administration of BPs after distal radius fracture did not result in a delay in healing. [31, 32] One key instance in which many authors report delayed healing to occur is with long-term use of bisphosphonates and development of atypical femoral fractures.…”

Section: Resultsmentioning

confidence: 99%

How do bisphosphonates affect fracture healing?

Kates

Ackert‐Bicknell

2016

Injury

105

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Bisphosphonates (BPs) have been in use for many years for the treatment of osteoporosis, multiple myeloma, Paget's disease, as well as a variety of other diseases in which there is reduced bone mineral density. Given that bisphosphonates inhibit bone resorption, an important stage of fracture healing; this class of compounds has been widely studied in preclinical models regarding their influence on fracture healing. In animal models, bisphosphonate treatment is associated with a larger fracture callus, coincident with a delay in remodeling from primary woven bone to lamellar bone, but there is no delay in formation of the fracture callus. In humans, de novo use of bisphosphonate therapy after fracture does not appear to have a significant effect on fracture healing. Rarely, patients with long term use of Bisphosphonates may develop an atypical fracture and delay in fracture healing has been observed. In summary, bisphosphonates appear safe for use in the setting of acute fracture management in the upper and lower extremity in humans. While much remains unknown about the effects on healing of long-term bisphosphonates, use prior to “typical” fracture, in the special case of atypical fracture, evidence suggests that bisphosphonates negatively influence healing.

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Section: Resultsmentioning

confidence: 99%

How do bisphosphonates affect fracture healing?

Kates

Ackert‐Bicknell

2016

Injury

105

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“…Little has been published about fracture healing in correlation to systemic antiosteoporotic medication [72]. Ng Aj et al could not demonstrate a significant change in non-or malunion rates in upper limb fractures with bisphosphonate medication [73]. Further studies will have to continue to elucidate the correlation between bone healing and systemic antiosteoporotic medication.…”

Section: Tt Treatmentmentioning

confidence: 97%

Distal humerus fractures: a review of current therapy concepts

Steinitz

Sailer

Rikli

2016

Curr Rev Musculoskelet Med

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Fractures of the distal humerus in the adult comprise approximately one third of all humeral fractures. Successful management of distal humerus fractures depends on correct reduction of the fracture, reconstruction of the articular surface if needed, stability and rigidity of the fixation, and appropriate rehabilitation. In this review, we evaluated the available literature and highlighted current therapy concepts. We assessed the evolution of internal fixation and elbow arthroplasty focusing on the established surgical approaches against the background of a growing incidence of distal humeral fractures in an aging patient population. Therefore evaluating the aspect and influence of age-dependent comorbidities like osteoporosis on successful treatment.

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“…A recent review on upper limb fractures associated with bisphosphonate treatment did not show any differences in union time between bisphosphonate users and nonusers [80]. …”

Section: Adverse Effects Of Bisphosphonates In Pediatric Patientsmentioning

confidence: 99%

The Use of Bisphosphonates in Pediatrics

Baroncelli

Bertelloni

2014

Horm Res Paediatr

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Bisphosphonates are widely used for the prevention and treatment of osteoporosis in adulthood. In the last years, bisphosphonates have been increasingly used in pediatric patients for the treatment of a growing number of disorders associated with osteoporosis, resistant hypercalcemia or heterotopic calcifications. The use of bisphosphonates in pediatric patients has been proven safe; however, the risk of potential severe consequences into adulthood should be kept in mind. Well-defined criteria for bisphosphonates treatment in pediatric patients are not specified, therefore an accurate selection of patients who could benefit from bisphosphonates is mandatory. A strict follow-up of pediatric patients receiving long-term bisphosphonate therapy is strongly recommended. The purpose of this mini review is to provide a summary of current knowledge on some main general aspects of the structure, mechanisms of action, pharmacokinetics, and bioavailability of bisphosphonates, and to focus on the latest advances of bisphosphonate treatment in pediatric patients. Particular attention has been paid to the common and potential adverse effects of bisphosphonate treatment, and some suggestions concerning the clinical approach and general measures for bisphosphonate treatment in pediatric patients are reported.

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Delayed/non‐union of upper limb fractures with bisphosphonates: systematic review and recommendations

Abstract: Differences in union time between BP users and non-users are not significant enough to change current practice patterns and do not outweigh the benefits of BP therapy. There is no evidence to encourage early surgical management of BP-related upper limb fractures.

Cited by 19 publications

References 36 publications

How do bisphosphonates affect fracture healing?

How do bisphosphonates affect fracture healing?

Distal humerus fractures: a review of current therapy concepts

The Use of Bisphosphonates in Pediatrics

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