Experts Evaluate Role of Osteoporosis Medications in Fracture Healing

Teriparatide has beneficial effect

In people with osteoporosis, one fracture often leads to more fractures and potentially to a future of pain, disability, and poor quality of life. With the goals of improving patient care and promoting future clinical studies, the International Osteoporosis Foundation (IOF) convened a panel of experts to review the existing literature and to vote on the appropriateness of care for fracture healing.

The multidisciplinary panel used a validated consensus method––the RAND USCLA Appropriateness Methodology (RUAM)––to find agreement on statements and scenarios for the following issues: the effect of osteoporosis medications on fracture healing; risk factors for delayed fracture healing; clinical and research goals; guidelines for future trial design; and clinical scenarios of fracture healing.

In regard to the effect of osteoporosis medications on fracture healing, the key panel agreements included the following:

  • Delayed fracture healing is common. Preventing delayed fracture healing should be a goal of providers treating patients with fractures. It is valuable to identify those patients at increased risk of delayed fracture healing as early as possible in order to consider intervention.
  • Antiresorptive agents, such as bisphosphonates, may delay fracture healing; however, the risk is low. There was no evidence for a delay in fracture healing when injectable bisphosphonates were administered in the first two weeks after fracture.
  • Anabolic agents that enhance osteoblastic bone formation, such as teriparatide, may have a beneficial effect on fracture healing.

In conclusion, the experts agreed that osteoporosis medications do not have a negative effect on fracture healing, and that it is safe to start osteoporosis medications as soon as possible after both vertebral and nonvertebral fractures. However, the panel agreed that after the occurrence of an atypical femur fracture, bisphosphonate therapy should be stopped. Treatment with an anabolic agent, such as teriparatide, should be considered to improve healing.

Professor Cyrus Cooper, chair of the IOF Committee of Scientific Advisors (CSA), commented:

“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.”

The consensus report was published in Osteoporosis International.

Source: IOF; April 26, 2016.