The orthopedic treatment is fixation of the fracture. How to treat the osteoporosis? Stop the bisphosphonates?
Osteoporosis is the general disease. I believe the drug therapy should be continued. I do not see any reason to discontinue it after the surgical fixation of the fracture.
Dear Panayot
Studies have shown an increased risk of atypical femoral fractures in patients taking bisphosphonates for five or more years, suggesting a dose response relationship.Recombinant parathyroid hormone (teriparatide) should also be considered, especially as there is evidence to suggest that teriparatide improves bone turnover and microarchitecture in patients on long-term alendronate treatment. Furthermore, teriparatide enhances and accelerates fracture healing by increasing callus formation and mechanical strength. Additional clinical trials also showed that teriparatide shortened the time to healing in patients with osteoporotic fractures. Therefore, teriparatide may be beneficial to enhance fracture healing in patients with atypical femoral fractures. Unnanuntana, A, et al.J Bone Joint Surg Am. 2013;95:e8(1-13)
There is a space of uncertainty around the role of biphosphonates in the etiology of the so-called atypical femoral fractures. Some studies blame genetic or other predisposing factors. Further research is needed to solve the avalanche of controversies in the literature. Aguing between firmas in the last years also plays some role. As far as teriparatide is concerned, it seems to be more efficient in combination with denosumab. In any case some concerns exist about the use of these medications and their connection to cancer and osteosarcomas in animals.
- Badges
- Science topic
- Similar topics
- Social Science
- Media
- Journalism