Timing of osteoporosis therapies following fracture: the current status

Abstract

In most patients, osteoporosis is diagnosed only after the occurrence of the first fragility fracture. It is of utmost importance to start osteoporosis medications immediately in these patients to prevent future fractures and also to reduce associated mortality and morbidity. There remains a hesitancy over initiating osteoporotic medications, specifically for antiresorptive agents like bisphosphonates following an acute fracture due to concern over their effect on fracture healing. The purpose of this review is to study the effect of the timing of initiation of different osteoporosis medications on healing after an acute fracture. Most of the human studies, including randomized control trials (RCTs), did not find any significant negative effect on fracture healing with early use of bisphosphonate after an acute fracture. Anabolic agents like teriparatide have shown either neutral or beneficial effects on fracture healing and thus can be started very early following any osteoporotic fracture. Although human studies on the early use of other osteoporosis medications like denosumab or strontium ranelate are very sparse in the literature, none of these medications have shown any evidence of delay in fracture healing. To summarize, among the commonly used anti-osteoporosis agents, both bisphosphonates and teriparatide are safe to be initiated in the early acute post-fracture period. Moreover, teriparatide has shown some evidence in favor of reducing fracture healing time.

Mechanistic advances in osteoporosis and anti‐osteoporosis therapies

“…Although taking Bps does potentially negatively affect the remodeling of the fracture callus, it will not lead to delayed healing 147 . So, it is still recommended to be used early in osteoporotic fractures 148 …”

“…147 So, it is still recommended to be used early in osteoporotic fractures. 148 Currently, risedronate and ibandronate are only approved to treat PMOP. Alendronate and zoledronate are also authorized by the Food and Drug Administration (FDA) to increase bone mass in men with osteoporosis and treat glucocorticoid-induced osteoporosis and Paget's disease of bone (a chronic osteomatoid degeneration that can cause bone expansion, deformity and strength reduction).…”

The Potential Therapeutic Effects of Platelet-Derived Biomaterials on Osteoporosis: A Comprehensive Review of Current Evidence

“…Osteoporosis can also affect the bone microarchitecture which also results in more complex healing of fractures and osseous defects [ 66 ]. Since implants are one of the most predictable treatment modalities to restore function and esthetics in hard tissues [ 67 , 68 ], the effect of osteoporosis on implant stability and survival rate has also been widely studied [ 69 – 74 ].…”

Mining Potential Drug Targets for Osteoporosis Based on CeRNA Network

“… 9 Another study showed that monoclonal antibody teriparatide may be effective for the treatment of osteoporotic fractures, but it was still controversial. 10 Therefore, clarifying the pathogenesis of OP at the molecular level and developing related drugs are becoming urgent requirements.…”

“…Currently, the main treatment methods for OP are drug therapy, such as estrogen, bisphosphonate, etc., but their side effects and poor oral absorption cannot be ignored 9 . Another study showed that monoclonal antibody teriparatide may be effective for the treatment of osteoporotic fractures, but it was still controversial 10 . Therefore, clarifying the pathogenesis of OP at the molecular level and developing related drugs are becoming urgent requirements.…”