Effect of osteoporosis medications on fracture healing

Abstract

Antiosteoporotic medications are often used to concurrently treat a patient's fragility fractures and underlying osteoporosis. This review evaluates the existing literature from animal and clinical models to determine these drugs' effects on fracture healing. The data suggest that these medications may enhance bone healing, yet more thorough prospective studies are warranted. Pharmacologic agents that influence bone remodeling are an essential component of osteoporosis management. Because many patients are first diagnosed with osteoporosis when presenting with a fragility fracture, it is critical to understand how osteoporotic medications influence fracture healing. Vitamin D and its analogs are essential for the mineralization of the callus and may also play a role in callus formation and remodeling that enhances biomechanical strength. In animal models, antiresorptive medications, including bisphosphonates, denosumab, calcitonin, estrogen, and raloxifene, do not impede endochondral fracture healing but may delay repair due to impaired remodeling. Although bisphosphonates and denosumab delay callus remodeling, they increase callus volume and result in unaltered biomechanical properties. Calcitonin increases cartilage formation and callus maturation, resulting in improved biomechanical properties. Parathyroid hormone, an anabolic agent, has demonstrated promise in animal models, resulting in accelerated healing with increased callus volume and density, more rapid remodeling to mature bone, and improved biomechanical properties. Clinical data with parathyroid hormone have demonstrated enhanced healing in distal radius and pelvic fractures as well as postoperatively following spine surgery. Strontium ranelate, which may have both antiresorptive and anabolic properties, affects fracture healing differently in normal and osteoporotic bone. While there is no effect in normal bone, in osteoporotic bone, strontium ranelate increases callus bone formation, maturity, and mineralization; forms greater and denser trabeculae; and improves biomechanical properties. Further clinical studies with these medications are needed to fully understand their effects on fracture healing in order to simultaneously treat fragility fractures and underlying osteoporosis.

Eldecalcitol, in Combination with Bisphosphonate, Is Effective for Treatment of Japanese Osteoporotic Patients

“…Vitamin D plays an important role in maintaining bone and calcium metabolism (Hegde et al 2015). Vitamin D deficiency causes not only low bone mineral density (BMD) via secondary hyperparathyroidism, but also impairment of bone mineralization (Watanabe and Okazaki 2013).…”

A closer look at fracture healing

“…21 Given the measured short-term reproducibility in this study and a statistical confidence level of 95%, the LSC for the bone density parameters is approximately 2%. The LSC for the micro-architectural parameters the was 14% and 11% for the biomechanical parameters.…”

“…Such findings are subjective, and their validity in quantifying fracture healing and bone strength has therefore been questioned. [19][20][21] Radiographic evidence of callus formation is dependent on the bone involved and the type and environment of the fracture. 22 As described, cortical bone fractures start healing at the periosteal and endosteal sites, producing plenty of callus ( Figure 1).…”

“…It has been validated in patients with any or multiple disorders of the upper limb. [18][19][20][21] QuickDASH uses eleven items to measure physical function and symptoms on a 0 to 100 scale with higher scores representing greater disability. Further, patients were asked to rate their pain on a visual analogue scale (VAS) ranging from 0 (no pain) to 100 (most severe pain).…”

“…[11][12][13] Moreover, biomechanical properties of the bone can be calculated by micro finite element analysis (mFEA) based on such HRpQCT images. 11,14,15 So far, these high-resolution imaging techniques were mainly used to study micro-architectural changes due to ageing 16,17 , osteoporosis and other (bone) diseases 15,18,19 and the effect of different treatments [20][21][22][23] . These techniques, however, could be applied as well to analyze the process of bone healing after a distal radius fracture.…”