title: Does bisphosphonate-based anti-osteoporosis medication affect osteoporotic spinal fracture healing?
abstract: Effects of bisphosphonate on fracture healing were prospectively investigated for osteoporotic spinal fracture. Although there were no significant differences in clinical outcomes, the presence of intravertebral cleft was related to the medication use. These results suggest that suspension of bisphosphonate use should be considered during the fracture healing period.
  
  
  BACKGROUND
  The purpose of this prospective study is to investigate whether bisphosphonate-based anti-osteoporosis medication affects fracture healing and clinical outcomes of conservatively treated osteoporotic spinal fractures (OSFs).
  
  
  METHODS
  A total of 105 patients who were diagnosed with acute OSFs were prospectively enrolled. According to their previous medication history, the patients were allocated into group I (n = 39, no history of bisphosphonate use) or group II (n = 66, history of bisphosphonate use). Clinical outcomes were assessed using visual analogue scale (VAS), and Oswestry disability index (ODI). Radiographic parameters including changes in height loss and kyphotic angle at the index vertebra were measured, and radiographic findings suggesting impaired fracture healing such as the intravertebral cleft (IVC) sign and fracture instability were evaluated. Univariate and multivariate regression analyses were used to identify related factors.
  
  
  RESULTS
  There were no significant differences in the last VAS and ODI between groups. There were also no significant differences in the radiographic parameters. Although the IVC sign was seen more commonly in group II (30.3 %) than in group I (20.5 %), fracture instability combined with IVC was noted in the same number of cases. On multiple regression analysis, medication history showed no significant relationship with the clinical parameters. However, the presence of the IVC sign was related to medication history (odds ratio 4.8; 95 % confidence interval [CI] 1.02-22.69).
  
  
  CONCLUSIONS
  Bisphosphonate use does not significantly affect the clinical results during conservative treatment for OSFs. However, the occurrence of the IVC sign was related to medication history. Although further studies are needed to verify our findings, these results suggest that suspension of bisphosphonate use should be considered during the fracture healing period for acute OSFs.
authors.affiliation: Department of Orthopedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-Daero, Seocho-Gu, Seoul, 137-701, Republic of Korea.
authors.forename: K-Y
authors.initials: KY
authors.lastname: Ha
authors.affiliation: Department of Orthopedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-Daero, Seocho-Gu, Seoul, 137-701, Republic of Korea.
authors.forename: K-S
authors.initials: KS
authors.lastname: Park
authors.affiliation: Department of Orthopedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-Daero, Seocho-Gu, Seoul, 137-701, Republic of Korea.
authors.forename: S-I
authors.initials: SI
authors.lastname: Kim
authors.affiliation: Department of Orthopedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-Daero, Seocho-Gu, Seoul, 137-701, Republic of Korea. boscoa@catholic.ac.kr.
authors.forename: Y-H
authors.initials: YH
authors.lastname: Kim
mesh_terms: D000368:Aged; D015519:Bone Density / Q000187:drug effects / Q000502:physiology; D050071:Bone Density Conservation Agents / Q000009:adverse effects / Q000494:pharmacology* / Q000627:therapeutic use; D004164:Diphosphonates / Q000009:adverse effects / Q000494:pharmacology* / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D017102:Fracture Healing / Q000187:drug effects* / Q000502:physiology; D005599:Fractures, Ununited / Q000139:chemically induced / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000188:drug therapy* / Q000503:physiopathology; D058866:Osteoporotic Fractures / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000628:therapy; D011446:Prospective Studies; D016103:Spinal Fractures / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000628:therapy
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates
keywords: Bisphosphonates; Nonunion; Osteoporosis; Osteoporotic spinal fractures