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Last year, Mother was advised by her doctor to start taking Fosamax for her osteoporosis. She refused. Then last week, she fell and broke her wrist. The doctor insisted she start taking this medication now. She's a pretty smart lady and went on-line and found that maybe this drug would slow her fracture healing. So she's refusing again. Is there anything you can tell me that might help me convince her to follow her doctor's advice? Help!
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Older adults who have osteoporosis (brittle bones) are more likely to fracture their wrists when they reach out their hand(s) to catch themselves during a fall. Surgeons are faced with an interesting dilemma when treating these folks. Should they put them on a bisphosphonate during the healing process? If so, how soon should bisphosphonate therapy begin?
Bisphosphonates are a group of drugs that inhibits (prevents) bone-resorption. In the normal day-to-day life of our bones, there are certain bone cells called osteoclasts that break down bone, allowing it to be absorbed by the body. But at the same time, there are also osteoblasts that build bone back up with new, healthy, strong bone cells.
The effects of osteoporosis can be slowed down by preventing osteoclasts from breaking down bone so rapidly. That's important in preventing complications of osteoporosis like bone fractures. However, after a fracture, the normal healing process involves osteoclasts coming in and clearing away the bone fragments and debris in preparation for fracture healing (new bone coming in and filling in the gaps).
The question arises: If an older adult who has osteoporosis fractures a bone and is given a bisphosphonate to help slow the osteoporosis process, will this drug treatment also slow the fracture healing process?
Studies are being done in this area to help sort out what to take and when to take it in the treatment of osteoporosis and subsequent fragility fractures. One study in particular might have some information that could be useful to you for your mother.
A study from South Korea involved 50 women aged 51 and older who had a wrist fracture and surgery to stabilize the fracture. They were divided into two groups. The first group was put on a bisphosphonate (alendronate/Fosamax) two weeks after surgery. Group two had the same fracture, got the same surgery (volar locking plates), and then started taking the same bisphosphonate three months later.
Results between the two groups were compared using X-rays to compare fracture healing (union versus nonunion) after two, six, 10, 16, and 24 weeks (six months). Other measures of outcomes compared between the two groups included wrist motion, grip strength, and hand function.
There was no difference between the two groups -- either radiographically or clinically. Everyone healed up nicely in about the same amount of time (six weeks). Healing did not seem to be hampered by the presence of osteoporosis. The authors offer two possible explanations for this surprising finding.
One: maybe surgery using the rigid plate to hold the bone together stabilized the fracture enough that only a one-step process of healing between the bone fragments was required. Without stabilization, the fracture might require the addition of bone crossing the fracture lines, a process called bridging. We don't know your mother's situation and whether she has a surgically stabilized fracture or not.
And two: the site of these fractures (wrist) is an area where there is extra room between all the bones. This "spacious environment" (as they refer to it) allows for more new bone to form thus balancing the resorption process.
The conclusion of this study was that medications such as bisphosphonates can be given to patients with osteoporosis who have not been on a bisphosphonate and who then suffer a wrist fracture. Taking these medications (designed to slow down bone resorption) does not appear to hinder fracture healing. Treating the osteoporosis is important to prevent future fractures and that's an important point to make with your mother.
Ultimately, the decision remains with your mother but with a little education and a lot of encouragement from family and physician, she might come to understand the need for this type of treatment. She is very fortunate to have caring family members willing to hear her concerns, honor and respect her wishes, but also offer a voice of reason and common sense. Good luck!
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