Table 3.
Summary of effect of osteoporosis treatment on fracture healing in animal studies.
| Mechanism | Medication group | Non osteoporotic animal models | Osteoporotic animal models (female) | |
|---|---|---|---|---|
| Antiresorptive | Bisphosphonates | Male ↑ callus formation 32, 33, 38 ↑ biomechanical strength [35] Histologically advanced healing [34] No effect on biomechanical strength 36, 38 No effect on radiological healing [34] No effect on incidence non-union 33, 36 Delay remodelling 33, 35, 37 |
Female ↑ bone mineral content/density [38] ↑ callus formation [39] |
↑ bone mineral content [25] ↑ callus formation 19, 40, 42 ↑ biomechanical strength 19, 40, 41 Histologically advanced healing [40] No effect on biomechanical strength [43] No effect on radiological healing [41] No effect on callus formation [43] No effect on incidence non-union [41] Delay remodelling 25, 41, 42 |
| Selective estrogen receptor modulator (SERM) | Male – |
Female ↑ bone mineral content [38] ↑ biomechanical strength [38] ↑ newly formed bone [44] |
↑ callus formation [46] ↑ biomechanical strength [45] Histological advanced healing [45] No effect on callus formation [25] No effect on biomechanical properties [25] Delay remodelling [25] |
|
| RANK ligand inhibitor | Male ↑ biomechanical strength [35] Delay remodelling [35] |
Female No effect on callus formation [47] No effect on biomechanical strength [47] Delay remodelling [47] |
– | |
| Anabolic | Parathyroid hormone | Male ↑ bone mineral content 50, 54/density 49, 54 ↑ callus formation 49, 50, 51, 52 ↑ newly formed bone 32, 33, 39, 50, 53 ↑ biomechanical strength 49, 50, 51, 53 Histological advanced healing [55] Improved radiological healing [49] Improved union rate [55] No effect on union rate [51] |
Female ↑ bone mineral content 38, 56/density [56] ↑ newly formed bone 38, 57 ↑ biomechanical strength 38, 56 Improved union rate [57] |
↑ bone mineral content 58, 61/density [61] ↑ callus formation [59] ↑ newly formed bone 61, 63, 64, 65, 66 ↑ biomechanical strength 59, 60 Improved union rate [57] No effect on callus formation [58] No effect on radiological healing [58] |
| Dual effect | Strontium ranelate | Male No effect on fracture healing [68] No effect on radiological healing [68] |
Female ↑ callus formation [38] ↑ bone mineral density [38] ↑ biomechanical strength [38] No effect on biomechanical strength [67] |
↑ callus formation 22, 69, 70, 71 ↑ newly formed bone [69] ↑ bone mineral density 69, 70 ↑ biomechanical strength 69, 71 No effect on fracture healing [14] |
↑ significant increased, ↓ significant decreased.