Does Bisphosphonate Delay Bone Healing After Proximal Femoral Nail Anti-Rotation

Abstract BackgroundBisphosphonates are widely used for osteoporotic patients to decrease the rate of osteoporotic fractures and they have been shown to reduce the mortality rate in clinical trials. A yearly intravenous zoledronic acid in a clinical study (The HORIZON-RFT) significantly reduced any new clinical fracture and also secondary prevention of hip fracture while bisphosphonates are known to delay remodeling of bone raising the risk that they may delay fracture healing. However, current studies lack data demonstrating whether bisphosphonate (BPs) delays bone healing after hip fracture treatment in clinical practice. Purpose of study was to determine whether treating elderly patients with Bisphosphonate (BP’s) after proximal femoral nail fixation (PFNA) for intertrochanteric fractures delays fracture healing compared to similar patients not treated with BP’s. A secondary goal was to compare the functional outcome, complications and mortality between the two treatment groups.MethodsOne hundred ninety-six elderly patients underwent PFNA fixation for intertrochanteric fracture between 2015 and 2017 with age > 60 years and minimum 1-year follow-up inclusive of functional scores and complications.Intervention: Surgical treatment of intertrochanteric fracture plus calcium and vitamin D supplementation.Main Outcome Measurements: Time to clinical union and radiographic union (weeks), the functional outcome (Harris Hip Score) and complications including mechanical failure and mortality rate. Setting: Level 1 Trauma CenterResults There were comparable functional class and comorbidity between those with BP’s and not treated BP’s. In addition, there was no different in mortality rate (4.0%% vs 6.6%, p=0.537), time to clinical union (6.0 weeks vs 6.0 weeks, p=0.822), radiographic union (11.8 weeks vs 12.0 weeks, p=0.849), and functional outcome (Harris Hip Score) (74.4 vs 69.9, p=0.177) between two groups.ConclusionsBP’s can be used after surgical treatment of an osteoporotic hip fracture without concern that fracture healing will be delayed.Level of Evidence: Prognostic level III.