BoneKEy Reports | BoneKEy Watch

Surgical intervention successful for BP-related incomplete fractures


This small, retrospective cohort study followed women aged between 46 and 92 who had been taking bisphosphonates (BPs) for just over 9 years on average, and who had sustained incomplete fractures.

The rate of healing was slow, with union taking an average of 9 months but as long as 36 months. Of 43 separate fractures studied, 21 required further surgical intervention. This provided the opportunity for Egol et al. to compare fracture healing and recovery in the women treated with surgery and in those offered non-surgical alternatives, including cessation of BP therapy, weight-bearing exercises, the use of an external bone stimulator or teriparatide therapy.

The difference between the two groups was marked; women treated surgically all experienced radiographic fracture healing within 1.5 to 12 months, and 81% were pain free, whereas only 18% of fractures in the non-surgical group had healed by 24 months and only 64% of women in this group were pain free at the last follow-up.

Editor’s comment: Patients with incomplete BP-related femoral fractures have a higher chance of becoming pain free and achieving fracture union after surgical treatment. Previous studies on non-operative management have also demonstrated poor outcomes, so we now await studies investigating whether active treatment with anabolic agents can aid fracture healing without surgery.

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