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Effects of anti-osteoporosis medications on osteoporotic hip fractures

摘要


Introduction: In treating osteoporotic hip fractures, the orthopaedic surgeon is often the first physician to address the fragility fracture and is in a unique position to make every effort to treat, prevent subsequent fractures, and minimize the need for subsequent revision surgery. Osteoporotic medications are split into two major categories: the antiresorptive medications, consisting of bisphosphonates (BPs), receptor activator of nuclear factor kappa-B ligand (RANKL) inhibitor, and selective estrogen receptor modulators (SERMs), and the anabolic agents, which include recombinant parathyroid hormone (rPTH) and strontium ranelate (SR). Purpose: This review focuses on the effects of widely-used osteoporosis medications with regard to osteoporotic hip fractures, including BPs, RANKL inhibitor and rPTH. All have been approved by the Taiwanese Food and Drug Administration (FDA) for treatment of osteoporosis in men and in postmenopausal women. Methods: We evaluate the existing animal and clinical studies to determine these drugs’ effects on perioperative treatment of osteoporotic hip fracture. Results: Most current studies have reported that osteoporosis medications had a positive effect on regular orthopedic surgeries and may enhance bone healing, yet the evidence of those studies were limited in retrospective design. Conclusion: Early administration of anti-osteoporosis medications may be beneficial in osteoporotic hip fracture. During the selection of anti-resorptive agents and anabolic agents, many factors should be taken into consideration. Further prospective randomized large-scale cohort studies are warranted for evidence-based recommendations.

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