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Antiresorptives – Part 2

February 8, 2011 @ 6:30 pm
posted by Dr Ginther

Antiresorptive medications for osteoporosis are primarily used when your bone is still good enough or just needs some additional Calcium to harden and stiffen the bone matrix.  Antiresorptives are a great way to prevent Osteoporosis.  Antiresorptives slow down the excessive bone turnover caused by “Osteoclasts Gone Wild”.

Some researchers worry that slowing down bone turnover can lead to the accumulation of microfractures.  This possibly could lead to two very rare conditions called Osteonecrosis of the Jaw (ONJ) and Atypical Fractures of the Femur.  There is not yet any conclusive evidence that this is true.  The chance of getting either of these conditions is similar to the chance of winning the daily Lotto or of being struck by lightning.  All Antiresorptives carry a warning from the FDA about these very rare possible events.

Fragility fractures are common complications of Osteoporosis.  Most orthopedic surgeons prefer to wait 6-12 weeks after a fracture before starting antiresorptive medications.  This prevents the possibility of the medicine slowing fracture healing.  Dentists and oral surgeons also prefer that antiresorptive medications not be given until 6-12 weeks after a tooth extraction.

Remember that none of these medications can work without enough Calcium and Vitamin D.

Jay Ginther, MD                                              

2008 / Revised Feb 2011

2 Responses to “Antiresorptives – Part 2”

  1. Linda Hightower says:

    Is there published information about when to start antiresorptives after fractures?

    • Dr. Ginther says:

      There are NO official studies designating time because that can vary a lot. Antiresorptives slow bone turnover which is part of the remodelling process in fracture healing.
      As an orthopedic surgeon, I want fracture healing completed before starting an Antiresorptive. That is at least 6 weeks, usually 2-3 months, sometimes 6 months.
      Anabolic meds (Forteo) stimulate bone turnover, possibly speeding healing. Therefore Forteo can be started very soon after fractures or orthopedic surgery.
      Cancellous (spongy) bones tend to heal faster and cortical (thick, tubular) bones slower. Ask your orthopod if the bone is fully healed.
      ## Dental surgery has similar considerations.

      Jay Ginther, MD


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