Effect of Antiresorptive Therapy on Development of Posttraumatic Osteoarthritis after Intra-articular Distal Radius Fracture in Female Patients

Abstract

Backgroud: Subchondral bone is a potential target for osteoarthritis (OA) prevention. Antiresorptive therapy has been demonstrated to be chondroprotective in surgically induced OA animal models, but results were mixed in clinical studies. We aimed to determine whether patients with traumatic joint injury could benefit from antiresorptive therapy and whether the osteoporosis status might affect the chondroprotective effect, if any, of the therapy.

Methods: We retrospectively reviewed 299 women (mean age, 64.7 ± 8.6 years) who underwent surgery for an intra-articular distal radius fracture (DRF). We evaluated radiographic and symptomatic OA development at 1 year postoperatively. The odds ratio (OR) for the OA development was analyzed using logistic regression for factors including age, lowest T score, bone mineral density, presence of osteoporosis, residual intra-articular step-off, and antiresorptive therapy. To delineate the effect of the osteoporosis status, subgroup analyses were performed.

Results: Development of radiographic OA was identified in 80 patients (27%), and the mean pain score on a visual analog scale was 2.2 ± 1.1. In the regression analysis, radiographic OA was associated with the presence of osteoporosis (OR, 3.97; 95% CI, 1.89-8.32), residual intra-articular step-off (OR, 3.68; 95% CI, 1.45-9.39), and not starting antiresorptive therapy (OR, 0.29; 95% CI, 0.14-0.61). In subgroup analysis, radiographic OA was associated with not starting antiresorptive therapy (OR, 0.24; 95% CI, 0.07-0.93) for patients without osteoporosis. However, for patients with osteoporosis, no association was found between radiographic OA and the evaluated factors.

Conclusions: Initiation of antiresorptive therapy was associated with a lower incidence of radiographic OA after an intra-articular DRF, especially in those without osteoporosis. This study suggests that attempts to decrease bone remodeling might be effective for OA prevention in a joint at risk.

Keywords: Bisphosphonates; Denosumab; Osteoarthritis; Osteoporosis; Radius fractures.

Fig. 1. (A-C) A 56-year-old woman with a distal radius fracture had undergone fixation surgery. Despite accurate reduction and successful union, joint space narrowing of the radiocarpal joint was evident 1 year later.