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Calcified Tissue International

, Volume 90, Issue 5, pp 343–353 | Cite as

Implications for Fracture Healing of Current and New Osteoporosis Treatments: An ESCEO Consensus Paper

  • J. Goldhahn
  • J.-M. Féron
  • J. Kanis
  • S. Papapoulos
  • J.-Y. Reginster
  • R. Rizzoli
  • W. Dere
  • B. Mitlak
  • Y. Tsouderos
  • S. Boonen
Review

Abstract

Osteoporotic fracture healing is critical to clinical outcome in terms of functional recovery, morbidity, and quality of life. Osteoporosis treatments may affect bone repair, so insights into their impact on fracture healing are important. We reviewed the current evidence for an impact of osteoporosis treatments on bone repair. Treatment with bisphosphonate in experimental models is associated with increased callus size and mineralization, reduced callus remodeling, and improved mechanical strength. Local and systemic bisphosphonate treatment may improve implant fixation. No negative impact on fracture healing has been observed, even after major surgery or when administered immediately after fracture. Experimental data for denosumab and raloxifene suggest no negative implications for bone repair. The extensive experimental results for teriparatide indicate increased callus formation, improved biomechanical strength, and greater external callus volume and total bone mineral content and density. Case reports and a randomized trial have produced mixed results but are consistent with a positive impact of teriparatide on clinical fracture healing. Studies with strontium ranelate in models of fracture healing indicate that it is associated with improved bone microstructure, callus volume, and biomechanical properties. Finally, there is experimental evidence for a beneficial effect of some of the agents currently being developed for osteoporosis, notably sclerostin antibody and DKK1 antibody. There is currently no evidence that osteoporosis treatments are detrimental for bone repair and some promising experimental evidence for positive effects on healing, notably for agents with a bone-forming mode of action, which may translate into therapeutic applications.

Keywords

Fractures Healing Bone formation Osteoporosis Treatment 

Notes

Acknowledgements

This article was derived from a working group meeting on December 2, 2010, supported by the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO).

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Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • J. Goldhahn
    • 1
  • J.-M. Féron
    • 2
  • J. Kanis
    • 3
  • S. Papapoulos
    • 4
  • J.-Y. Reginster
    • 5
  • R. Rizzoli
    • 6
  • W. Dere
    • 7
  • B. Mitlak
    • 8
  • Y. Tsouderos
    • 9
  • S. Boonen
    • 10
  1. 1.AO Clinical Priority Program “Fracture Fixation in Osteoporotic Bone”Institute for Biomechanics of ETHZurichSwitzerland
  2. 2.Department of Orthopaedic and Trauma SurgerySaint Antoine Hospital, AP-HP, UPMC-Sorbonne UniversitiesParisFrance
  3. 3.WHO Collaborating Centre for Metabolic Bone DiseasesUniversity of Sheffield Medical SchoolSheffieldUK
  4. 4.Department of Endocrinology and Metabolic DiseasesLeiden University Medical CenterLeidenThe Netherlands
  5. 5.Public Health and Health EconomicsUniversity of LiègeLiegeBelgium
  6. 6.Division of Bone Disease, Department of Rehabilitation and GeriatricsGeneva University Hospitals and Faculty of MedicineGenevaSwitzerland
  7. 7.Amgen, LtdUxbridgeUK
  8. 8.Lilly Corporate CenterEli Lilly and CompanyIndianapolisUSA
  9. 9.Institute de Recherches Internationales ServierCourbevoieFrance
  10. 10.Division of Gerontology and Geriatrics, Department of Experimental Medicine, Centre for Metabolic Bone DiseaseLeuven UniversityLeuvenBelgium

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