Consensus Report: Osteoporosis Meds Okay for Fracture Patients

Troy Brown, RN

May 09, 2016

Osteoporosis medications can be safely given as soon as possible in patients with both vertebral and nonvertebral fracture, according to a new consensus report from the International Osteoporosis Foundation (IOF) Working Group.

The group also said the medications would not further delay healing in patients with nonhealing nonvertebral fractures.

Using a structured expert-opinion process, the multidisciplinary panel addressed the use of osteoporosis medications in patients who have suffered a recent fracture and the use of osteoporosis medications for stimulating fracture healing.

Stuart Silverman, MD, of Cedars-Sinai Medical Center, Los Angeles, California, and colleagues from the IOF Working Group published the report online April 25 in Osteoporosis International.

"Our experts agreed that there was no negative effect of osteoporosis medications on fracture healing and that it is safe to start osteoporosis medications as soon as possible after both vertebral and nonvertebral fracture," Dr Silverman and colleagues state.

Commenting in an IOF news release, Cyrus Cooper, chair of the IOF Committee of Scientific Advisors, added: "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," Dr Cooper notes.

Clinical Scenarios of Fracture Healing Discussed

The expert panel included both members and nonmembers of the IOF Fracture Working Group and consisted of geriatricians, rheumatologists, orthopedists, endocrinologists, and internists.

The objectives included reviewing existing literature in the field and voting on appropriateness of care for fracture healing.

They aimed to reach a consensus on the effect of osteoporosis medications on fracture healing, risk factors associated with delayed fracture healing, clinical and research goals, and guidelines for the design of future trials.

The group also commented on a range of clinical scenarios of fracture healing, representing a wide range of hypothetical patients needing a treatment decision.

The panel's conclusions and recommendations include:

  • Delayed healing of fractures is common. Providers should strive to prevent delayed fracture healing, and it is important to identify high-risk patients as early as possible.

  • Antiresorptives including bisphosphonates may delay fracture healing, but the risk is low. No delay in fracture healing was found when patients received injectable bisphosphonates in the first 2 weeks after a fracture.

  • Anabolic agents such as teriparatide, which improve osteoblastic bone formation, may be beneficial for fracture healing.

  • Stop bisphosphonate therapy after the occurrence of an atypical femur fracture, and consider teriparatide to improve healing.

  • Guidelines for the design of future trials to elucidate the role of osteoporosis medications on fracture healing.

"We hope that this consensus report will help to set the scene for both improved patient care and good clinical study design for future research in this area," Dr Silverman concluded.

Dr Silverman reports consulting for Amgen, Alexion, Eli Lilly, and Pfizer and being a member of the speakers' bureau for Lilly and Pfizer. He has received research grants from Pfizer, Lilly, and Amgen. Disclosures for the coauthors are listed in the article.

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Osteoporosis Int. Published online April 25, 2016. Article

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