Implications for fracture healing of current and new osteoporosis treatments: an ESCEO consensus paper

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.