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Orthopedic Services
Glendale Adventist Medical Center
1509 Wilson Terrace
Glendale, CA 91206
Ph: (818) 409-8000

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Can you help me understand something? I fell and broke my wrist and right away the doctor wanted to put me on Fosamax for my osteoporosis. But if I understand this drug correctly, it keeps the bone from destroying bone cells. And isn't it important for normal, healthy bone to get rid of old bone cells and replace them with new? So, if I have a broken bone that needs new cells to heal, won't this drug keep that from happening? I'm confused by the information my doctor gave me and what I'm reading on-line.

You are definitely pursuing an important line of reasoning. And you are close to correct. Here's a little information that might help you sort this out. Bisphosphonates are a group of drugs that inhibit (prevent) 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. This process is referred to as bone resorption. At the same time, there are also osteoblasts that build bone back up with new, healthy, strong bone cells. The balance between osteoclast function and the work of the osteoblasts results in a perfect amount of bone turnover necessary to maintain strong, healthy bones. Osteoporosis or "brittle bones" occurs when there is a decrease in bone mineral density. This occurs when the osteoclast function (bone resorption) outpaces the osteoblast (bone building) process. The effects of osteoporosis can be slowed down by taking bisphosphonate medications and thus prevent osteoclasts from breaking down bone so rapidly. That's important in preventing complications of osteoporosis like bone fractures. 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). So we need that osteoclast function. The question arises: If an older adult who has osteoporosis then fractures a bone and is given a bisphosphonate to help slow the osteoporosis process (by slowing the bone resorption/osteoclast function), will this drug treatment also slow the fracture healing process? A complete answer to this question is not available just yet. Some studies suggest yes while others say no.There are many variables and factors involved. For example, is there a difference in fracture healing if someone has already been taking a bisphosphonate before the fracture compared with someone who doesn't start taking one until after the fracture? Does it matter how long before (or how long after) the fracture patients have been taking (or start to take) the drug? Does age make a difference or the location and severity of the fracture? What about the severity of the osteoporosis? Does that make a difference? Does the type of treatment influence the results (surgery to stabilize the fracture versus immobilization without surgery)? There is some evidence that bisphosponates can be taken without any negative effect on healing when surgical fixation (metal plate to hold the bones together) is done. Animal and human studies are underway to sort these questions all out and find some more answers with clinical application to guide treatment.


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