Stumpf Ulla, Schmidmaier Ralf, Taipaleenmäki Hanna, Böcker Wolfgang, Kurth Andreas, Hesse Eric
Klinik für Orthopädie und Unfallchirurgie, LMU Klinikum, LMU München, München, Deutschland.
Osteologisches Schwerpunktzentrum DVO (OSZ), Bayerisches Osteoporose-Zentrum, LMU Klinikum, LMU München, München, Deutschland.
Z Rheumatol. 2025 Mar;84(2):107-112. doi: 10.1007/s00393-024-01610-y. Epub 2025 Jan 14.
Osteoporosis is a widespread disease defined by a reduction in bone mass and structure, thereby increasing the risk of fragility fractures. Treatment typically involves specific medications, which either inhibit bone resorption (antiresorptive) or stimulate bone formation (anabolic) and may potentially influence the healing of osteoporotic fractures. On the other hand, metabolic disorders, immune system dysfunctions or circulatory problems can impair fracture healing. Therefore, the targeted use of osteoporosis medications could be a strategy to promote the healing of impaired fractures.
The aim of this study is to provide a current overview of the effects of osteoporosis medications approved in Germany on fracture healing. The focus is on the potential influence of these medications in the context of osteoporosis treatment. Additionally, the current state of research is examined to explore to what extent the targeted use of these medications could improve fracture healing.
A literature search was conducted in the PubMed database using topic-specific keywords. Preclinical studies, clinical trials, review articles and meta-analyses were considered to present the current scientific knowledge with clinical relevance.
Preclinical and clinical studies suggest that specific osteoporosis medications do not have a clinically relevant negative impact on the healing of fragility fractures. Osteoanabolic substances even tend to have a positive effect on fracture healing in both normal and impaired healing processes; however, the available studies are limited and none of the medications have been approved for this specific use.
Osteoporosis medications with antiresorptive or osteoanabolic effects are primarily used to treat osteoporosis, especially after fragility fractures, to reduce the risk of further fractures. There is no clinically relevant impairment of fracture healing due to these medications. Further studies would be required to obtain approval for these medications specifically to improve fracture healing.
骨质疏松症是一种广泛存在的疾病，其定义为骨量和骨结构减少，从而增加脆性骨折的风险。治疗通常涉及特定药物，这些药物要么抑制骨吸收（抗吸收），要么刺激骨形成（合成代谢），并且可能潜在地影响骨质疏松性骨折的愈合。另一方面，代谢紊乱、免疫系统功能障碍或循环问题会损害骨折愈合。因此，有针对性地使用骨质疏松症药物可能是促进受损骨折愈合的一种策略。
本研究的目的是提供德国批准的骨质疏松症药物对骨折愈合影响的最新概述。重点是这些药物在骨质疏松症治疗背景下的潜在影响。此外，还研究了当前的研究状况，以探讨这些药物的有针对性使用在多大程度上可以改善骨折愈合。
在PubMed数据库中使用特定主题关键词进行文献检索。考虑纳入临床前研究、临床试验、综述文章和荟萃分析，以呈现具有临床相关性的当前科学知识。
临床前和临床研究表明，特定的骨质疏松症药物对脆性骨折的愈合没有临床相关的负面影响。骨合成代谢物质甚至在正常和受损愈合过程中都倾向于对骨折愈合产生积极影响；然而，现有研究有限，且没有一种药物已被批准用于这种特定用途。
具有抗吸收或骨合成代谢作用的骨质疏松症药物主要用于治疗骨质疏松症，尤其是在脆性骨折后，以降低进一步骨折的风险。这些药物不会对骨折愈合造成临床相关的损害。需要进一步研究以获得这些药物专门用于改善骨折愈合的批准。
