title: Early initiation of bisphosphonate does not affect healing and outcomes of volar plate fixation of osteoporotic distal radial fractures.
abstract: BACKGROUND
  Bisphosphonates can adversely affect fracture-healing because they inhibit osteoclastic bone resorption. It is unclear whether bisphosphonates can be initiated safely for patients who have sustained an acute distal radial fracture. The purpose of this randomized study was to determine whether the early use of bisphosphonate affects healing and outcomes of osteoporotic distal radial fractures treated with volar locking plate fixation.
  
  
  METHODS
  Fifty women older than fifty years of age who had undergone volar locking plate fixation of a distal radial fracture and had been diagnosed with osteoporosis were randomized to Group I (n = 24, initiation of bisphosphonate treatment at two weeks after the operation) or Group II (n = 26, initiation of bisphosphonate treatment at three months). Patients were assessed for radiographic union and other radiographic parameters (radial inclination, radial length, and volar tilt) at two, six, ten, sixteen, and twenty-four weeks, and for clinical outcomes that included Disabilities of the Arm, Shoulder and Hand (DASH) scores, wrist motion, and grip strength at twenty-four weeks. The two groups were compared with regard to the time to radiographic union, the radiographic parameters, and the clinical outcomes.
  
  
  RESULTS
  No significant differences were observed between the two groups with respect to radiographic or clinical outcomes after volar locking plate fixation. All patients obtained fracture union, and the mean times to radiographic union in Groups I and II were similar (6.7 and 6.8 weeks, respectively; p = 0.65). Furthermore, the time to radiographic union was not related to osteoporosis severity or fracture type.
  
  
  CONCLUSIONS
  In patients with an osteoporotic distal radial fracture treated with volar locking plate fixation, the early initiation of bisphosphonate treatment did not affect fracture-healing or clinical outcomes.
  
  
  METHODS
  Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea.
authors.forename: Hyun Sik
authors.initials: HS
authors.lastname: Gong
authors.forename: Cheol Ho
authors.initials: CH
authors.lastname: Song
authors.forename: Young Ho
authors.initials: YH
authors.lastname: Lee
authors.forename: Seung Hwan
authors.initials: SH
authors.lastname: Rhee
authors.forename: Hyuk Jin
authors.initials: HJ
authors.lastname: Lee
authors.forename: Goo Hyun
authors.initials: GH
authors.lastname: Baek
mesh_terms: D015502:Absorptiometry, Photon; D000368:Aged; D000704:Analysis of Variance; D001863:Bone Screws; D016009:Chi-Square Distribution; D003131:Combined Modality Therapy; D004164:Diphosphonates / Q000008:administration & dosage*; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000295:instrumentation* / Q000379:methods; D017102:Fracture Healing / Q000187:drug effects* / Q000502:physiology; D006801:Humans; D008875:Middle Aged; D015663:Osteoporosis, Postmenopausal / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy; D011182:Postoperative Care / Q000379:methods; D011446:Prospective Studies; D011885:Radius Fractures / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D012016:Reference Values; D018570:Risk Assessment; D013997:Time Factors; D016896:Treatment Outcome; D014954:Wrist Injuries / Q000000981:diagnostic imaging / Q000601:surgery
chemical_list: D004164:Diphosphonates