Use of bisphosphonates for the treatment of stress fractures in athletes

Abstract

A literature review was performed to investigate the potential role of bisphosphonates (BPs) for the treatment of stress fractures in athletes. Given the inhibitory action on osteoclast-mediated bone resorption, short-term suppression of bone remodeling using BPs could potentially treat stress fractures and prevent stress fractures to become regular fractures. To date, while there are some animal studies showing the scientific basis of BPs on stress fractures, we must say that there is still no conclusive evidence to prove any effect of BPs on stress fracture healing in humans. Further well-designed clinical trials should be carried out to establish their usefulness and safety. Until the results are available, it is prudent to limit the use of BPs for the treatment of stress fractures.

Stress Fractures of the Tibia

“…Although bisphosphonates are successful pharmacologic agents in the treatment of osteoporosis and osteopenia, their use in patients with tibial stress fractures is not currently recommended [27]. Despite the mechanism of action of bisphosphonate medications (inhibition of osteoclast-mediated bone resorption seen in early stress fracture), their clinical use has no high-level evidence in either the prevention or treatment of tibial stress fractures [28]. Although parathyroid hormone derivatives have been shown to improve stress fracture repair in animal models, their clinical use has no high-level evidence in either the prevention or treatment of tibial stress fractures [29].…”

Severe osteogenesis imperfecta Type-III and its challenging treatment in newborn and preschool children. A systematic review

“…Long-term use of bisphosphonates is believed to be associated with an increased risk of stress fractures in some (adult) patients [36][37][38]. In this so-called ''frozen bone'' situation, bone metabolism slows down locally and zones that are susceptible to stress fractures appear especially in the femoral area (Fig.…”

Stress Fracture / Stress Reaction of the Lower Leg and Foot

“…However, bisphosphonates are expensive and can have adverse effects such as oesophageal inflammation or severe muscle, bone, and joint pain. Given these contraindications as well as the lack of conclusive evidence, it is prudent to restrict the use of bisphosphonates for the treatment of stress fractures (Shima et al 2009). …”