AAOS Asks: Which Medication is “Best” After a Fracture?
Here at the American Academy of Orthopedic Surgeons Annual Meeting, the most common question is: “Which Osteoporosis Medication should I use after a fracture?” We need to know how each type of medication works to answer that.
Immediately after a fracture, or a surgery on bone, or a tooth extraction, you want a medicine which will not slow down bone healing. Better yet, you would like to stimulate bone formation and remodeling. Anabolic Medications do that. Teriparatide (Forteo) is the Anabolic available in the USA.
Anabolic medications act mostly by stimulating the cells that make new bone matrix. This helps initial healing. They also mildly stimulate the cells that eat away bone, which helps remodel the initial healing into fully healed bone.
As an orthopedic surgeon, I prefer anabolic (bone building) action during early bone healing. Therefore, if osteoporosis medication is needed after a fracture, I usually prescribe the Anabolic.
All Antiresorptives (Fosamax, Alendronate, Boniva, Actonel, Reclast, and Prolia) act primarily by slowing down the cells that eat away bone. But they also slow down the cells that make new bone. Therefore they can sometimes slow down bone healing, and can occasionally stop it all together. This is not good after a fracture.
As an orthopedic surgeon, I always wait until solid bone healing is seen on an x-ray before starting an Antiresorptive after a fracture. I also always recommend stopping Antiresorptive medication, after a fracture, until solid healing is seen.
Choosing osteoporosis medication after a fracture is a special situation where Anabolic action is usually “best”.
Jay Ginther, MD, FAAOS