[The influence of bisphosphonates on fracture healing]

As the population ages and the prevalence of osteoporotic fractures increases, perioperative medical care of the elderly will continue to present challenges. Bisphosphonates, in combination with calcium and vitamin D have become the first-line therapy for patients with osteoporosis. Thus, one of the frequently asked questions concerning such patients is whether individuals who have recently sustained a fracture should take inhibitors of bone resorption. This discussion is relevant because many of the patients treated with bisphosphonates do have fractures, such as patients with osteoporosis, tumor bone disease, Paget's disease or osteogenesis imperfecta. A recent fracture should not preclude the initiation of therapy, because bisphosphonates have not been shown to interfere with overall fracture strength. Bisphosphonates appear to affect callus formation differently from either estrogen or raloxifene, but no significant difference in callus strength was seen 16 weeks after fracture. In addition, current studies demonstrate a significant reduction in periprosthetic bone loss after uncemented primary hip arthroplasty.