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Choosing a Treatment for Patients at the Time a Fracture is Presented

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Abstract

The occurrence of a fragility fracture is an opportunity to recognize osteoporosis and begin treatment to reduce the risk of another fracture. However, selecting the treatment may have an impact on the incident fracture and this requires careful consideration of the patient and the treatment choices. There is no consensus regarding the management of osteoporosis at the time of an incident fracture. This review will consider the treatment options after a fragility fracture.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Klotzbuecher CM, Ross PD, Landsman PB, et al. Patients with prior fractures have an increased risk of future fractures: a summary of the literature and statistical synthesis. J Bone Miner Res: The Official Journal of the American Society for Bone and Mineral Research. 2000;15:721–39.

    CAS  Google Scholar 

  2. Kannegaard PN, van der Mark S, Eiken P, Abrahamsen B. Excess mortality in men compared with women following a hip fracture. National analysis of comedications, comorbidity and survival. Age Ageing. 2010;39:203–9.

    Article  PubMed  Google Scholar 

  3. Feldstein AC, Nichols G, Orwoll E, et al. The near absence of osteoporosis treatment in older men with fractures. Osteoporos Int. 2005;16:953–62.

    Article  PubMed  Google Scholar 

  4. Watts NB, Lewiecki EM, Miller PD, Baim S. National Osteoporosis Foundation 2008 Clinician’s Guide to Prevention and Treatment of Osteoporosis and the World Health Organization Fracture Risk Assessment Tool (FRAX): what they mean to the bone densitometrist and bone technologist. J Clin Densitom. 2008;11:473–7.

    Article  PubMed  Google Scholar 

  5. Qaseem A, Snow V, Shekelle P, et al. Pharmacologic treatment of low bone density or osteoporosis to prevent fractures: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2008;149:404–15.

    PubMed  Google Scholar 

  6. • Watts NB BJ, Camacho PM, Greenspan SL, Harris ST, Hodgson SF, Kleerekoper M, Luckey MM, McClung MR, Pollack RP, Petak SM. American Association of Clinical Endocrinologists medical guidelines for clinical practice for the diagnosis and treatment of post menopausal osteoporosis. Endocr Pract. 2010;16 supplement 3:1–37. This is a comprehensive and useful set of guidleines for the management of osteoporosis.

    PubMed  Google Scholar 

  7. Tannenbaum C, Clark J, Schwartzman K, et al. Yield of laboratory testing to identify secondary contributors to osteoporosis in otherwise healthy women. J Clin Endocrinol Metab. 2002;87:4431–7.

    Article  PubMed  CAS  Google Scholar 

  8. •• Mehsen N, Paccou J, Confavreux CB, et al. Management of patients with incident fractures during osteoporosis treatment. Joint Bone Spine 2010;77 Suppl 2:S133–8. This article has a thoughtful series of six questions to use when evaluating the fracture patient already on osteoporosis treatment to help calrify if the patient is a “treatment failure” and how to procede.

    Article  PubMed  Google Scholar 

  9. Nurmi-Lüthje I, Sund R, Juntunen M, Lüthje P. Post-hip fracture use of prescribed calcium plus vitamin D or vitamin D supplements and anti-osteoporotic drugs are associated with lower mortality. A nationwide study in Finland. J Bone Miner Res. 2011;n/a–n/a.

  10. Gregory PC, Lam D, Howell P. Osteoporosis treatment following hip fracture: how rates vary by service. South Med J. 2010;103:977–81.

    Article  PubMed  Google Scholar 

  11. Owens GM. Gender differences in health care expenditures, resource utilization, and quality of care. J Manag Care Pharm. 2008;14:2–6.

    PubMed  Google Scholar 

  12. Harrington JT, Lease J. Osteoporosis disease management for fragility fracture patients: New understandings based on three years’ experience with an osteoporosis care service. Arthritis Care Res. 2007;57:1502–6.

    Article  Google Scholar 

  13. Cree MW, Juby AG, Carriere KC. Mortality and morbidity associated with osteoporosis drug treatment following hip fracture. Osteoporos Int. 2003;14:722–7.

    Article  PubMed  Google Scholar 

  14. • Semerano L, Guillot X, Rossini M, et al. What predicts initiation of osteoporosis treatment after fractures: education organisation or patients’ characteristics? Clin Exp Rheumatol 2011;29:89–92. This recent work speaks to the need for predischarge treatment initiation of osteoporosis treatment when a patient has been hospitalized with a fragility fracture.

    PubMed  Google Scholar 

  15. Kiebzak GM, Moore NL, Margolis S, et al. Vitamin D status of patients admitted to a hospital rehabilitation unit: relationship to function and progress. Am J Phys Med Rehabil. 2007;86:435–45.

    Article  PubMed  Google Scholar 

  16. Ellegaard M, Jørgensen N, Schwarz P. Parathyroid hormone and bone healing. Calcif Tissue Int. 2010;87:1–13.

    Article  PubMed  CAS  Google Scholar 

  17. • Bukata S, Puzas J. Orthopedic Uses of Teriparatide. Curr Osteoporos Rep. 2010;8:28–33. This is an excellent review of the details of teriparitide and its effects on fracture and bone healing.

    Article  PubMed  Google Scholar 

  18. Kakar S, Einhorn TA, Vora S, et al. Enhanced chondrogenesis and Wnt signaling in PTH-treated fractures. J Bone Miner Res. 2007;22:1903–12.

    Article  PubMed  CAS  Google Scholar 

  19. Aspenberg P, Genant HK, Johansson T, et al. Teriparatide for acceleration of fracture repair in humans: a prospective, randomized, double-blind study of 102 postmenopausal women with distal radial fractures. J Bone Miner Res: The Official Journal of the American Society for Bone and Mineral Research. 2010;25:404–14.

    CAS  Google Scholar 

  20. Chintamaneni S, Finzel K, Gruber B. Successful treatment of sternal fracture nonunion with teriparatide. Osteoporos Int. 2010;21:1059–63.

    Article  PubMed  CAS  Google Scholar 

  21. Barnes GL, Kakar S, Vora S, et al. Stimulation of fracture-healing with systemic intermittent parathyroid hormone treatment. J Bone Joint Surg Am. 2008;90:120–7.

    Article  PubMed  Google Scholar 

  22. Gomberg SJ, Wustrack RL, Napoli N, et al. Teriparatide, Vitamin D, and calcium healed bilateral subtrochanteric stress fractures in a postmenopausal woman with a 13-year history of continuous alendronate therapy. J Clin Endocrinol Metab. 2011;96:1627–32.

    Article  PubMed  CAS  Google Scholar 

  23. Maricic M. The role of zoledronic acid in the management of osteoporosis. Clin Rheumatol. 2010;29:1079–84.

    Article  PubMed  Google Scholar 

  24. Van Beek E, Lowik C, Que I, Papapoulos S. Dissociation of binding and antiresorptive properties of hydroxybisphosphonates by substitution of the hydroxyl with an amino group. J Bone Miner Res: The Official Journal of the American Society for Bone and Mineral Research. 1996;11:1492–7.

    Google Scholar 

  25. Baron R, Ferrari S, Russell RGG. Denosumab and bisphosphonates: different mechanisms of action and effects. Bone. 2011;48:677–92.

    Article  PubMed  CAS  Google Scholar 

  26. Roelofs AJ, Hulley PA, Meijer A, et al. Selective inhibition of Rab prenylation by a phosphonocarboxylate analogue of risedronate induces apoptosis, but not S-phase arrest, in human myeloma cells. Int J Cancer. 2006;119:1254–61.

    Article  PubMed  CAS  Google Scholar 

  27. Adolphson P, Abbaszadegan H, Boden H, et al. Clodronate increases mineralization of callus after Colles’ fracture: a randomized, double-blind, placebo-controlled, prospective trial in 32 patients. Acta Orthop Scand. 2000;71:195–200.

    Article  PubMed  CAS  Google Scholar 

  28. Van Der Poest Clement E, Patka P, Vandormael K, et al. The effect of alendronate on bone mass after distal forearm fracture. J Bone Miner Res. 2000;15:586–93.

    Article  PubMed  Google Scholar 

  29. Lyles KW, Colon-Emeric CS, Magaziner JS, et al. Zoledronic acid and clinical fractures and mortality after hip fracture. N Engl J Med. 2007;357:1799–809.

    Article  PubMed  CAS  Google Scholar 

  30. Brufsky AM, Bosserman LD, Caradonna RR, et al. Zoledronic acid effectively prevents aromatase inhibitor-associated bone loss in postmenopausal women with early breast cancer receiving adjuvant letrozole: Z-FAST study 36-month follow-up results. Clin Breast Cancer. 2009;9:77–85.

    Article  PubMed  CAS  Google Scholar 

  31. Ringe JD, Dorst A, Faber H, et al. Intermittent intravenous ibandronate injections reduce vertebral fracture risk in corticosteroid-induced osteoporosis: results from a long-term comparative study. Osteoporos Int. 2003;14:801–7.

    Article  PubMed  CAS  Google Scholar 

  32. •• Bukata SV. Systemic administration of pharmacological agents and bone repair: What can we expect. Injury 2011;In Press. This is the best summary of the current and future pharmacologic agents used with osteoporosis treatment and bone healing.

  33. McDonald MM, Dulai S, Godfrey C, et al. Bolus or weekly zoledronic acid administration does not delay endochondral fracture repair but weekly dosing enhances delays in hard callus remodeling. Bone. 2008;43:653–62.

    Article  PubMed  CAS  Google Scholar 

  34. Amanat N, McDonald M, Godfrey C, et al. Optimal timing of a single dose of zoledronic acid to increase strength in rat fracture repair. J Bone Miner Res. 2007;22:867–76.

    Article  PubMed  CAS  Google Scholar 

  35. Rozental TD, Vazquez MA, Chacko AT, et al. Comparison of radiographic fracture healing in the distal radius for patients on and off bisphosphonate therapy. J Hand Surg. 2009;34:595–602.

    Article  Google Scholar 

  36. Eriksen EF, Lyles KW, Colón-Emeric CS, et al. Antifracture efficacy and reduction of mortality in relation to timing of the first dose of zoledronic acid after hip fracture. J Bone Miner Res. 2009;24:1308–13.

    Article  PubMed  CAS  Google Scholar 

  37. Thillemann TM, Pedersen AB, Mehnert F, et al. Postoperative use of bisphosphonates and risk of revision after primary total hip arthroplasty: a nationwide population-based study. Bone. 2010;46:946–51.

    Article  PubMed  CAS  Google Scholar 

  38. Munns CF, Rauch F, Zeitlin L, et al. Delayed osteotomy but not fracture healing in pediatric osteogenesis imperfecta patients receiving pamidronate. J Bone Miner Res: The Official Journal of the American Society for Bone and Mineral Research. 2004;19:1779–86.

    CAS  Google Scholar 

  39. Black DM, Kelly MP, Genant HK, et al. Bisphosphonates and Fractures of the Subtrochanteric or Diaphyseal Femur. N Engl J Med. 2010;362:1761–71.

    Article  PubMed  CAS  Google Scholar 

  40. Schilcher J, Michaëlsson K, Aspenberg P. Bisphosphonate use and atypical fractures of the femoral shaft. N Engl J Med. 2011;364:1728–37.

    Article  PubMed  CAS  Google Scholar 

  41. Milgrom C, Finestone A, Novack V, et al. The effect of prophylactic treatment with risedronate on stress fracture incidence among infantry recruits. Bone. 2004;35:418–24.

    Article  PubMed  CAS  Google Scholar 

  42. Cummings SR, San Martin J, McClung MR, et al. Denosumab for prevention of fractures in postmenopausal women with osteoporosis. N Engl J Med. 2009;361:756–65.

    Article  PubMed  CAS  Google Scholar 

  43. Reid IR, Miller PD, Brown JP, et al. Effects of denosumab on bone histomorphometry: the FREEDOM and STAND studies. J Bone Miner Res: The Official Journal of the American Society for Bone and Mineral Research. 2010;25:2256–65.

    CAS  Google Scholar 

  44. Delmas PD. Clinical potential of RANKL inhibition for the management of postmenopausal osteoporosis and other metabolic bone diseases. J Clin Densitom. 2008;11:325–38.

    Article  PubMed  Google Scholar 

  45. Gerstenfeld LC, Sacks DJ, Pelis M, et al. Comparison of effects of the bisphosphonate alendronate versus the RANKL inhibitor denosumab on murine fracture healing. J Bone Miner Res. 2009;24:196–208.

    Article  PubMed  CAS  Google Scholar 

  46. Adami S, Palacios S, Pavalka K, et al. FREEDOM TRIAL: densoumab is not associated with fracture healing complications in postmenopausal women with osteoporosis. Osteoporos Int. 2011;22 Suppl 1:S243–4.

    Google Scholar 

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Disclosure

Conflicts of interest: S.B. Tanner: is a Board volunteer for the International Society for Clinical Densitometry (ISCD); has received grant support from Pfizer, UCB, Astra Zeneca, Roche, Centocor, and Eli Lilly; has received honoraria from Eli Lilly, Amgen, Bristol-Myers Squibb, Pfizer, Merck, Novartis, and ISCD; has received travel/accommodations expenses covered or reimbursed from Eli Lilly, Amgen, Pfizer, Merck, Bristol-Myers Squibb, and UCB; has had advisory meetings with Eli Lilly, UCB, and Genentech; and has been on the P & T committee for Windsor Medical.

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  1. Divisions of Rheumatology, Allergy & Immunology, Vanderbilt University Medical Center, 2611 West End Avenue, Suite 210, Nashville, TN, 37203, USA

    S. Bobo Tanner

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Correspondence to S. Bobo Tanner.

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Tanner, S.B. Choosing a Treatment for Patients at the Time a Fracture is Presented. Curr Osteoporos Rep 9, 156–159 (2011). https://doi.org/10.1007/s11914-011-0061-4

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  • DOI: https://doi.org/10.1007/s11914-011-0061-4

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