Review Question - QID 211749

Resuming bisphosphonates at 1-week post-op has not been associated with any detrimental clinical outcomes.

Osteoporotic hip fractures are a tremendous burden on the aging population and portend future fragility fractures. Treatment with bisphosphonates has been proven to increase bone mineral density and reduce the risk of future osteoporotic fractures. Bisphosphonates alter osteoclast function to reduce bone resorption, which may be a concern for fracture remodeling after treatment of osteoporotic hip fractures. However, recent studies have demonstrated no difference in delayed-union or nonunion with early administration of bisphosphonates.

Cho et al. retrospectively analyzed 284 intertrochanteric hip fractures treated with bisphosphonates postoperatively that were initiated at various time points. The authors reported the mean time-to-union to be 12.4, 11.9, and 12.3 weeks post-op in patients starting bisphosphonates at 1 week, 1 month, and 3 months postop, respectively, with no reported cases of nonunion. The authors concluded bisphosphate administration after treatment of osteoporotic hip fractures has no effect on clinical outcomes.

Lindsay et al. reviewed the outcomes of teriparatide treatment for osteoporosis. Data infers teriparatide increases more remodeling sites and enhances bone formations greater the bone resorption at already active sites. The authors suggest an entire 24-month course of teriparatide due to the improved skeletal outcomes over shorter courses.

Figure A is an AP radiograph of the right hip demonstrating a displaced intertrochanteric hip fracture.

Incorrect answers
Answers 1, 2, 3, and 5: Resuming bisphosphonates 1-week postop from hip fracture surgery is not associated with hardware cutout, nonunion, avascular necrosis, or decreased time-to-union.