Abstract
SummaryThe appropriate time to initiate bisphosphonate treatment after a fragility fracture has not yet been established. In this study, we found no significant differences in short-term functional recovery between femoral neck fracture patients who received bisphosphonate treatment at 2 versus 12 weeks after hemiarthroplasty.IntroductionBisphosphonate is the mainstay therapy for prevention and treatment of osteoporosis. The aim of this study was to investigate the effect of bisphosphonate initiation on short-term functional recovery in femoral neck fracture patients at 2 versus 12 weeks after hemiarthroplasty.MethodsOne hundred patients were randomly allocated into two groups in a parallel group designed, randomized, controlled trial. Both groups received risedronate 35 mg/week at either 2 or 12 weeks after hemiarthroplasty. All patients received calcium and vitamin D supplementation. Functional recovery was assessed by de Morton Mobility Index, Barthel Index, EuroQol 5D, visual analog scale, 2-min walk test, and timed get-up-and-go test at 2 weeks, 3 months, and 1 year after surgery.ResultsAt the 3-month follow-up, all functional outcome measures showed significant improvement in both groups. There were no statistically significant differences in any of the functional outcomes between groups at both the 3-month and 1-year follow-ups. Although patients who received bisphosphonate initiation at week 2 had lower serum calcium level at 3 months and more overall adverse events than patients in the week 12 group, no patients in either group discontinued their prescribed medications.ConclusionsWhile underpowered, the findings of this study suggest that there were no significant differences in short-term functional recovery or significant adverse events between the two bisphosphonate groups. Thus, the initiation of bisphosphonate therapy may be considered as early as 2 weeks after femoral neck fracture. It is important that low serum calcium and vitamin D status must be corrected with calcium and vitamin D supplementation prior to or at the time of bisphosphonate initiation.Clinical trial registration numberThis study was registered in the database via the Protocol Registration and Results System (PRS) (NCT02148848).
Highlights
Hip fracture is a common osteoporotic fracture among the elderly and is a major public health concern worldwide [1]
While underpowered, the findings of this study suggest that there were no significant differences in short-term functional recovery or significant adverse events between the two bisphosphonate groups
Exclusion criteria were as follows: pathologic fracture; multiple fractures; patients with history of abnormalities of the esophagus that delay esophageal emptying, such as stricture or achalasia; patients who were unable to remain upright for 30 min after dosing; patients with hypocalcemia, severe vitamin D deficiency (serum 25-hydroxyvitamin D (25(OH)D)
Summary
Hip fracture is a common osteoporotic fracture among the elderly and is a major public health concern worldwide [1]. The cost of treating a hip fracture patient is high, with costs being approximately three times higher than those incurred when caring for a patient without a fracture [9, 10]. It is, essential to develop an effective prevention program and to initiate osteoporosis treatment in these patients to prevent or minimize the chance of future fracture. Many strategies have been implemented to manage osteoporosis patients, the rate of osteoporosis evaluation and treatment remains low [11] This may suggest that some physicians had insufficient participation in the prevention of their patients’ secondary fracture. If an intervention with good efficacy can be implemented soon after a fragility fracture has been diagnosed, it is plausible to assume that the rate of osteoporosis treatment will increase
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