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Title: Delayed/non-union of upper limb fractures with bisphosphonates: systematic review and recommendations.
Epworth Authors: Richardson, Martin
Other Authors: Ng, A.
Yue, B.
Joseph, S.
Keywords: Alendronate
Bone and Bones
Fractures, Bone
Bone Fractures
Fracture Healing
Fractures, Malunited
Fractures, Abnormal Union
Bone Remodeling
Clodronic Acid
Delayed Union
Epworth HealthCare Musculoskeletal Clinical Institute, Melbourne, Australia
Issue Date: Apr-2014
Publisher: Wiley Online Library
Citation: ANZ J Surg. 2014 Apr;84(4):218-24.
Abstract: BACKGROUND: Bisphosphonates (BPs) are widely used for the treatment of osteoporosis. Oversuppression of bone turnover with BPs may paradoxically limit the reserve capacity of bone to heal. The aim of this review was to study the predisposition of some patients to delayed/non-union of upper limb fractures associated with BPs and give recommendations on how they should be treated. METHODS: A systematic search of two electronic databases was conducted to identify relevant studies for inclusion. All relevant studies found were included and assessed through methodology criteria predetermined by two independent reviewers. RESULTS: Six papers comprising of three case reports, one nested case control study, one restrospective review and one randomized clinical trial were used. In comparative studies of pre-fracture BP use, a 6-day delay in average healing times was reported among BP users. There was no elevation in risk of non-union. Post-fracture BP use was associated with an approximate doubling of the risk of non-union. Timing of BP therapy initiation following a fracture was not associated with a difference in healing times. An atypical ulna fracture treated conservatively resulted in non-union, there was no effect of type of surgical treatment on distal radius fracture healing and there was insufficient evidence to comment on humeral fracture treatment. CONCLUSIONS: Differences in union time between BP users and non-users are not significant enough to change current practice patterns and do not outweigh the benefits of BP therapy. There is no evidence to encourage early surgical management of BP-related upper limb fractures.
DOI: 10.1111/ans.12536
PubMed URL:
ISSN: 1445-1433
Journal Title: ANZ Journal of Surgery
Type: Journal Article
Affiliated Organisations: Department of Orthopaedic Surgery, Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia.
Type of Clinical Study or Trial: Systematic Reviews
Appears in Collections:Musculoskeletal

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