With commentary by study lead Harpreet Bawa, MD, a fourth-year orthopedic resident at the University of Chicago Hospitals.
Medications that improve bone health can help men and women who have suffered one so-called fragility fracture avoid another one, new research has found.
In terms of treatment, "there are no set guidelines after a fracture about exactly what should happen," says Harpreet Bawa, MD, a fourth-year orthopedic resident at the University of Chicago Hospitals who led the study. It was published Oct. 7 in The Journal of Bone & Joint Surgery.
A fragility fracture is one that occurs from a fall from standing level or lower. When a person suffers a fracture from that moderate of a fall, it reflects poor bone health, experts say. Fragility fractures most often affect the hip, spine and wrists. Those who have one are at increased risk of having another one.
Dr. Bawa's team looked at a claims data base involving more than 31,000 men and women, all age 50 and over. All had suffered a fragility fracture in the wrist, upper arm, hip or vertebra. The researchers followed the medical records of the patients for three years after the original fracture. They compared the risk of fracture in those on anti-osteoporotic medicine and those who were not. About 10 percent were treated with the medications after the fracture.
The medications used included bisphosphonates (examples are Fosamax, Reclast), raloxifene (Evista), teriparatide (Forteo), denosumab (Xgeva) and calcitonin (Miacalcin). The question that Dr. Bawa wanted to address was, "Is it too late to treat after a fracture?"
He found it was not. The medications did help people avoid repeat fractures, he found. Bottom line? ''Even after sustaining a fragility fracture, there is a 40 percent decreased risk in a repeat fracture [over three years] with the initiation of anti-osteoporotic therapy," Dr. Bawa says.
The research was funded by the University of Chicago Hospitals orthopedic department, with no funds from pharmaceutical companies, Dr. Bawa says.
Because he looked at the medications overall, compared the medicated group with the non-medicated, he can't say which medicines might be better. One that was given, calcitonin, has now fallen out of favor, he says. "Some newer data doesn't support calcitonin, but before, we thought it was effective." If anything, including it in the analysis means that the overall risk reduction of the medications in favor today may be even greater than the 40 percent he found, Dr. Bawa says.
Not singling out which medications work better is definitely a study limitation, says Kevin Ong, PhD, principal engineer at the Philadelphia office of Exponent, an engineering and scientific consulting firm. He wrote a commentary to accompany the study. Even so, he says, ''what this study shows is, that as a class or a group, these therapies work and they are effective for a broad population of patients."
Comparing medications is the next step, says Dr. Bawa. In future research, he hopes to do head-to-head comparisons of various medications to see which work best for bone health. Many types of osteoporosis medications can help improve bone health. While some osteoporosis medicines work by slowing bone loss, other medications increase the rate of bone formation.
There were other study limitations, Dr. Bawa says. He did not have information about race, smoking status or the status of the participants' bone health, and all could have an effect on fracture risk.
Until more information is in, Dr. Bawa says that those who have had a fracture should be concerned and aware about the risk of having another. He suggests they should ask their doctors for a plan to reduce that risk.
"If they do incur some type of fragility fracture, I don't think it’s too late for them to prevent a subsequent fracture," Dr. Bawa says.
While there are no set recommendations for what to do after a fracture, there are guidelines for how to prevent them. These guidelines vary greatly, so "advice for patients is going to have to come down to talking to their physicians," Ong says. That advice is best based on an individual patient's history, he says.