Healing of the bone with anti-fracture drugs

ABSTRACT

Introduction: Fracture healing is a complex physiological process. As impaired fracture healing is more frequent in osteoporotic subjects, anti-osteoporotic drugs could have some impact on this process.

Areas covered: We reviewed the current literature to evaluate the effects of these drugs on fracture healing and their potential role in supporting this process, especially when impaired. A PubMed/Medline search was undertaken combining the terms ‘fracture healing’, ‘anti-resorptive drugs’, ‘anabolic agents’, ‘anti-osteoporotic drugs’.

Expert opinion: As clinical evidence on the role of anti-osteoporotic drugs in the process of fracture healing consists mainly of case reports or studies with a relatively small number of patients, large randomized clinical trials are needed in order to extend to the human setting the promising results on these agents as inductors or co-adjuvants of bone healing derived from animal studies.

KEYWORDS:

• Anti-fracture drugs
• anti-resorptive drugs
• bone anabolic drugs
• fracture healing
• fracture healing impairment

Article highlights

• Anti-resorptive drugs appear to be associated with the development of a larger and stronger fracture callus in experimental models

• Bone-inductive treatments seem to give the best results in terms of acceleration of fracture healing

• No clinically-relevant detrimental effects on the process of fracture healing appear to be related to the administration of anti-osteoporotic drugs after an acute fracture, particularly after a non-vertebral one.

• The proven anti-fracture efficacy of anti-osteoporotic therapies as a secondary fracture prevention surmounts concerns about theoretical impairment of the process of fracture repair, mainly related to the use of anti-catabolic drugs

• In case of fractures which repair via direct healing process, such as rigidly-fixed fractures or stress fractures, it seems to be safe to wait the complete union of the fracture before initiating bisphosphonate therapy

• Large randomized controlled trials are needed in order to clarify the role of anti-osteoporotic drugs as co-adjuvants of the fracture healing process

This box summarizes key points contained in the article.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Additional information

Funding

This paper was not funded.