28 studies and more than 5,000 patients: osteoporosis medications don't delay fracture healing, and the anabolic teriparatide may speed it. Here's why I start very-high-risk patients on an anabolic, not a bisphosphonate.
New in The Lancet Healthy Longevity: 28 studies, more than 5,000 patients. The takeaway is simple: you do not need to wait to treat osteoporosis after a broken bone.
For years there has been a worry that osteoporosis medications might interfere with a fracture healing, so treatment often got delayed. This study should put that fear to rest. The older, more common bone medications (bisphosphonates) did not slow healing or raise the risk of a bone failing to heal. In fact, one medication: teriparatide, an anabolic that actively builds bone, may have helped fractures heal faster by 3 weeks.
That matters, because a broken bone after a minor fall is the loudest warning sign we get. It tells us the next fracture is coming. The first fracture is a failure of prevention. The second fracture is neglect. Waiting to treat only buys time for that next break.
However, the bigger point for me is which drug we reach for first. This paper reinforces that the anabolic, teriparatide, may actually decrease time to fracture healing. Pair that with what sequencing data already shows: that anabolics build more bone in treatment-naive patients than starting with an antiresorptive, and I do not agree with defaulting to a bisphosphonate first in the recently fractured, VERY high-risk for fracture patient. Anabolic-first is the stronger play.
This is not a fringe position. The major guidelines already say it. American Association of Clinical Endocrinology (AACE), the Endocrine Society, Bone Health and Osteoporosis Foundation, The Menopause Society ALL recommend starting with an anabolic in patients at very high risk for fracture. And there is no higher risk than the patient who is status post fragility fracture. A recent fracture is the single clearest marker of very high risk, yet these are exactly the patients we too often start on a bisphosphonate by reflex.
It's worth noting this analysis did not really capture romosozumab, with only a single trial included. Romosozumab is a dual mechanism agent, building bone while reducing resorption, and it is available right now for exactly these patients. It deserves a seat at the table in this conversation, and more prospective data on healing would be welcome.
Wondering about your own bone health?
Book a ConsultationA systematic review and meta-analysis in The Lancet Healthy Longevity (28 studies, more than 5,000 patients) examined whether anti-osteoporosis medications affect fracture healing. Bisphosphonates did not delay healing or raise the risk of nonunion, and the anabolic teriparatide was associated with faster time to healing. Only a single romosozumab trial was included.
