In a retrospective study, bisphosphonates did not appear to interfere with fracture healing.

Bisphosphonates interfere with osteoclast activity and can affect bone remodelling. Thus, some clinicians have expressed concern that administering these drugs too soon after an osteoporosis-related fracture could interfere with fracture healing and lead to fracture nonunion. However, studies on this point have yielded mixed results.

In this latest study, researchers used US Medicare claims data from 2016 to 2019 to identify 111,000 patients (age, 65 years or older) with operatively treated long-bone fractures; most were lower-extremity fractures, but 11% were in an upper extremity. The incidence of fracture nonunion at one year was 9%. On multivariable analysis, receiving a bisphosphonate prescription within 90 days after fracture was not associated with nonunion. Notably, only 11% of patients received bisphosphonate prescriptions during one year after their fractures.

Comment: My sense is that orthopaedists now are more likely to encourage bisphosphonate use shortly after an osteoporotic fracture than they were in 2016 to 2019, when these patients were treated. Although claims-database research has well-known limitations, this study’s findings tip the scale further towards the safety of bisphosphonate therapy shortly after operative treatment of long-bone fractures.

Allan S. Brett, MD, Clinical Professor of Medicine, University of Colorado School of Medicine, Aurora, USA. 

Thorne TJ, et al. No increased risk of non-union with bisphosphonate use in a Medicare claims cohort following operatively treated long-bone fractures. J Bone Joint Surg Am 2023; 105: 549-555.

This summary is taken from the following Journal Watch titles: General Medicine, Ambulatory Medicine, Hospital Medicine.