Palui Rajan, Durgia Harsh, Sahoo Jayaprakash, Naik Dukhabandhu, Kamalanathan Sadishkumar
Department of Endocrinology, The Mission Hospital, Durgapur, India.
Dr. Harsh's Endocrine and Diabetes Center, Rajkot, India.
Ther Adv Endocrinol Metab. 2022 Jul 22;13:20420188221112904. doi: 10.1177/20420188221112904. eCollection 2022.
In most patients, osteoporosis is diagnosed only after the occurrence of the first fragility fracture. It is of utmost importance to start osteoporosis medications immediately in these patients to prevent future fractures and also to reduce associated mortality and morbidity. There remains a hesitancy over initiating osteoporotic medications, specifically for antiresorptive agents like bisphosphonates following an acute fracture due to concern over their effect on fracture healing. The purpose of this review is to study the effect of the timing of initiation of different osteoporosis medications on healing after an acute fracture. Most of the human studies, including randomized control trials (RCTs), did not find any significant negative effect on fracture healing with early use of bisphosphonate after an acute fracture. Anabolic agents like teriparatide have shown either neutral or beneficial effects on fracture healing and thus can be started very early following any osteoporotic fracture. Although human studies on the early use of other osteoporosis medications like denosumab or strontium ranelate are very sparse in the literature, none of these medications have shown any evidence of delay in fracture healing. To summarize, among the commonly used anti-osteoporosis agents, both bisphosphonates and teriparatide are safe to be initiated in the early acute post-fracture period. Moreover, teriparatide has shown some evidence in favor of reducing fracture healing time.
在大多数患者中，骨质疏松症是在首次脆性骨折发生后才被诊断出来的。对于这些患者，立即开始使用骨质疏松症药物以预防未来骨折，并降低相关的死亡率和发病率至关重要。在急性骨折后启动骨质疏松症药物，特别是像双膦酸盐这样的抗吸收剂时，仍存在犹豫，这是因为担心它们对骨折愈合的影响。这篇综述的目的是研究不同骨质疏松症药物开始使用的时间对急性骨折后愈合的影响。大多数人体研究，包括随机对照试验（RCT），均未发现急性骨折后早期使用双膦酸盐对骨折愈合有任何显著的负面影响。像特立帕肽这样的促合成代谢药物对骨折愈合显示出中性或有益的影响，因此在任何骨质疏松性骨折后都可以非常早期开始使用。尽管关于早期使用其他骨质疏松症药物如地诺单抗或雷奈酸锶的人体研究在文献中非常稀少，但这些药物均未显示出任何骨折愈合延迟的证据。总之，在常用的抗骨质疏松药物中，双膦酸盐和特立帕肽在骨折后早期急性阶段开始使用都是安全的。此外，特立帕肽已显示出一些有利于缩短骨折愈合时间的证据。
