Abstract
BackgroundWhether bisphosphonates affect indirect bone healing is still unclear.MethodWe carried out a comprehensive search strategy. Only randomized controlled trials were included. Two reviewers independently assessed methodological qualities and extracted outcome data. Analysis was performed with RevMan 5.2.ResultsEight eligible randomized controlled trials with 2,508 patients were included. Meta-analysis results showed that no statistically significant differences were founded in indirect bone healing in short time (within 3 months) (relative risk (RR) 1.40, relative the control group; 95% CI 0.36 to 5.49) and in long-term (more than 12 months) postoperation (RR 1.0; 95% CI 0.98 to 1.02) between bisphosphonates infusion groups and control groups. There were no statistically significant differences of indirect bone healing between early and delay bisphosphonates administration groups. Bisphosphonates infusion after lumbar infusion surgery could promote bone healing and shorten fusion time in 6 months postoperation (RR 1.35; 95% CI 1.11 to 1.66).ConclusionThere was no clinically detectable delay to fracture healing via external callus formation following bisphosphonates treatment. Considering the benefit aspects of bisphosphonates for osteoporosis treatment, we recommend bisphosphonates infusion after fracture fixation surgery and lumbar fusion surgery.
Highlights
There are two kinds of drugs which affect bone remolding, anabolic and anti-catabolic drugs
Meta-analysis results showed that no statistically significant differences were founded in indirect bone healing in short time (relative risk (RR) 1.40, relative the control group; 95% CI 0.36 to 5.49) and in long-term postoperation (RR 1.0; 95% CI 0.98 to 1.02) between bisphosphonates infusion groups and control groups
Bisphosphonates infusion after lumbar infusion surgery could promote bone healing and shorten fusion time in 6 months postoperation (RR 1.35; 95% CI 1.11 to 1.66)
Summary
There are two kinds of drugs which affect bone remolding, anabolic and anti-catabolic drugs. Most countries recommend anticatabolic drugs as the first line drugs for treating osteoporosis, especially bisphosphonates [2]. Bisphosphonates have an inhibitory effect on osteoclastic bone resorption. They have been used in diseases with increased bone turnover, such as osteoporosis, Paget's disease, and metastatic bone diseases [3,4,5]. Bisphosphonates inhibit osteoclast-mediated bone resorption which would prevent bone loss and improve bone strength [6,7]. Treating patients with bisphosphonates during bone healing is controversial because osteoclasts are important for remodeling callus into cortical bone [8]. Whether bisphosphonates affect indirect bone healing is still unclear
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