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Early BP treatment of intertrochanteric fracture does not delay healing


The inhibitory effect of bisphosphonates (BPs) on osteoclasts could theoretically have a negative effect on fracture healing since osteoclasts remodel the callus to form cortical bone. Kim et al. studied 90 elderly osteoporotic patients with no history of taking BPs and who presented with intertrochanteric fractures to investigate whether this is the case.

The patients were split into three groups; one was given risedronate treatment immediately after surgery performed for fracture fixation, the second group started therapy one month later and the third group had their BP treatment delayed for three months. Patients in all groups showed similar times to fracture healing (10.7, 12.9 and 12.3 weeks, respectively) and functional outcomes and complication rates were similar across the groups.

The findings suggest that bisphosphonate treatment after fracture does not adversely affect fracture repair. However, the authors highlight several limitations of the study, including sample size and differences in the implants chosen to fix the original fracture, which could have a bearing on fracture healing time.

Editor's comment: Despite little direct evidence, there is great clinical concern that early commencement of bisphosphonate treatment after a fracture may be problematic. This study is not large enough to completely refute these concerns but provides assurances that early treatment will not adversely affect outcomes.

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