Early bisphosphonate therapy post proximal femoral fracture fixation does not impact fracture healing: a systematic review and meta‐analysis

• Published in: ANZ journal of surgery 2022-11, Vol.92 (11), p.2840-2848
• Main Authors: Tong, Yui Yee Felice, Holmes, Samuel, Sefton, Andrew
• Format: Article
• Language: English
• Subjects: Adult; Biomedical materials; Bisphosphonates; Bone Density Conservation Agents - therapeutic use; Bone healing; Clinical trials; diphosphonates; Diphosphonates - therapeutic use; femoral fractures; Femoral Fractures - surgery; Femur; Fixation; Fracture Fixation - methods; Fracture Healing; Fractures; Healing; hip fractures; Humans; Meta-analysis; Osteoporosis; Osteoporotic Fractures; Osteosynthesis; Pain; Patients; Systematic review; Therapy; Trauma
• ISSN: 1445-1433; 1445-2197
• DOI: 10.1111/ans.17792

Background There is conjecture on the optimal timing to administer bisphosphonate therapy following operative fixation of low‐trauma hip fractures. Factors include recommendations for early opportunistic commencement of osteoporosis treatment, and clinician concern regarding the effect of bisphosphonates on fracture healing. We performed a systematic review and meta‐analysis to determine if early administration of bisphosphonate therapy within the first month post‐operatively following proximal femur fracture fixation is associated with delay in fracture healing or rates of delayed or non‐union. Methods We included randomized controlled trials examining fracture healing and union rates in adults with proximal femoral fractures undergoing osteosynthesis fixation methods and administered bisphosphonates within 1 month of operation with a control group. Data were pooled in meta‐analyses where possible. The Cochrane Risk of Bias Tool and the GRADE approach were used to assess validity. Results For the outcome of time to fracture union, meta‐analysis of three studies (n = 233) found evidence for earlier average time to union for patients receiving early bisphosphonate intervention (MD = −1.06 weeks, 95% CI −2.01–−0.12, I2 = 8%). There was no evidence from two included studies comprising 718 patients of any difference in rates of delayed union (RR 0.61, 95% CI 0.25–1.46). Meta‐analyses did not demonstrate a difference in outcomes of mortality, function or pain. Conclusions We provide low‐level evidence that there is no reduction in time to healing or delay in bony union for patients receiving bisphosphonates within 1 month of proximal femur fixation. Recent data from the ANZHFR suggests that over 70% of bisphosphonate‐naïve patients presenting to hospital with a low‐trauma hip fracture fail to receive initiation of antiresorptive therapy during their admission. Clinician uncertainty regarding delays in fracture union with early administration of bisphosphonate therapy may contribute to this. We performed a systematic review and meta‐analysis demonstrating low‐level evidence that early initiation of bisphosphonate therapy in the first month following hip fracture fixation is not associated with a delay to fracture union or rates of delayed or non‐union.