Early bisphosphonate therapy post proximal femoral fracture fixation does not impact fracture healing: a systematic review and meta‐analysis

BACKGROUND: There is conjecture on the optimal timing to administer bisphosphonate therapy following operative fixation of low‐trauma hip fractures. Factors include recommendations for early opportunistic commencement of osteoporosis treatment, and clinician concern regarding the effect of bisphosphonates on fracture healing. We performed a systematic review and meta‐analysis to determine if early administration of bisphosphonate therapy within the first month post‐operatively following proximal femur fracture fixation is associated with delay in fracture healing or rates of delayed or non‐union. METHODS: We included randomized controlled trials examining fracture healing and union rates in adults with proximal femoral fractures undergoing osteosynthesis fixation methods and administered bisphosphonates within 1 month of operation with a control group. Data were pooled in meta‐analyses where possible. The Cochrane Risk of Bias Tool and the GRADE approach were used to assess validity. RESULTS: For the outcome of time to fracture union, meta‐analysis of three studies (n = 233) found evidence for earlier average time to union for patients receiving early bisphosphonate intervention (MD = −1.06 weeks, 95% CI −2.01–−0.12, I(2) = 8%). There was no evidence from two included studies comprising 718 patients of any difference in rates of delayed union (RR 0.61, 95% CI 0.25–1.46). Meta‐analyses did not demonstrate a difference in outcomes of mortality, function or pain. CONCLUSIONS: We provide low‐level evidence that there is no reduction in time to healing or delay in bony union for patients receiving bisphosphonates within 1 month of proximal femur fixation.