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. 2009 Jun;20(6):895-901.
doi: 10.1007/s00198-008-0759-z. Epub 2008 Oct 9.

The relation between bisphosphonate use and non-union of fractures of the humerus in older adults

D H Solomon  1 , M C Hochberg, H Mogun, S Schneeweiss
Affiliations

The relation between bisphosphonate use and non-union of fractures of the humerus in older adults

D H Solomon et al. Osteoporos Int. 2009 Jun.

Abstract

Summary: While nitrogen-containing bisphosphonates have been shown to reduce fracture risk in postmenopausal women and men, their safety in the period after a fracture is unclear. In fully adjusted multivariable regression models, bisphosphonate use in the post-fracture period was associated with an increased probability of non-union [odds ratio (OR) 2.37, 95% confidence interval (CI) 1.13-4.96]. Clinicians might consider waiting for several months before introduction of a bisphosphonate after a fracture.

Introduction: While nitrogen-containing bisphosphonates have been shown to reduce fracture risk in postmenopausal women and men, their safety in the period after a fracture is unclear. We examined the risk of non-union associated with post-fracture bisphosphonate use among a group of older adults who had experienced a humerus fracture.

Methods: We conducted a nested case-control study among subjects who had experienced a humerus fracture. From this cohort, cases of non-union were defined as those with an orthopedic procedure related to non-union 91-365 days after the initial humerus fracture. Bisphosphonate exposure was assessed during the 365 days prior to the non-union among cases or the matched date for controls. Multivariable logistic regression models were examined to calculate the OR and 95% CI for the association of post-fracture bisphosphonate use with non-union.

Results: From the cohort of 19,731 patients with humerus fractures, 81 (0.4%) experienced a non-union. Among the 81 cases, 13 (16.0%) were exposed to bisphosphonates post-fracture, while 69 of the 810 controls (8.5%) were exposed in the post-fracture interval. In fully adjusted multivariable regression models, bisphosphonate use in the post-fracture period was associated with an increased odds of non-union (OR 2.37, 95% CI 1.13-4.96). Albeit limited by small sample sizes, the increased risk associated with bisphosphonate use persisted in the subgroup of patients without a history of osteoporosis or prior fractures (OR 1.91, 95% CI 0.75-4.83).

Conclusions: In this study of older adults, non-union after a humerus fracture was rare. Bisphosphonate use after the fracture was associated with an approximate doubling of the risk of non-union.

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Conflict of interest statement

Conflicts of interest There is no specific support for this project. Dr. Solomon receives salary support from the NIH (AR 047782, AR 055989, AG 027066, DA 022600) and AHRQ. He has served as an unpaid member of an Advisory Board to Amgen for a non-osteoporosis-related product. He provides epidemiologic consulting to CORRONA. Dr. Hochberg receives salary support from the NIH and the Department of Veterans Affairs and is a consultant to the following companies that have products in the field of osteoporosis: Amgen, Merck & Co., Inc., Novartis Pharma A.G., Proctor & Gamble Pharmaceutical Co., and Roche Pharmaceutical Co. Dr. Schneeweiss is Principal Investigator of the Brigham and Women’s Hospital DEcIDE Research Center on comparative effectiveness research funded by the Agency of Healthcare Research and Quality.

Figures

Fig. 1
Fig. 1
The adjusted relative risk and 95% confidence intervals based on models that included all variables listed in Table 1. Since the events are rare, the calculated odds ratios approximate the relative risk. a The results for post-fracture and pre-fracture bisphosphonate use. b The results for post-fracture bisphosphonate use among patients without a prior fracture nor a diagnosis of osteoporosis and without surgery at the time of the humerus fracture
See this image and copyright information in PMC

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