What’s New in Osteoporosis and Fragility Fractures 2022

The recent JBJS Guest Editorial “What’s New in Osteoporosis and Fragility Fractures” provides an update on this important area of orthopaedic research. The authors review recent studies on the assessment of bone strength, calcium and vitamin D supplementation, medications to prevent bone loss and reduce fracture risk, and other key topics. Here, we present the 5 most intriguing findings, as selected by co-author Derek G. Hansen, MD. 

Vitamin D 

– A randomized controlled trial evaluated vitamin D3 supplementation on distal radial fracture healing¹. Thirty-two women ≥ 50 years of age were randomized to 1 of 3 groups: no vitamin D, a low bolus of D3 (equivalent to 700 IU per day), or a high bolus of D3 (equivalent to 1,800 IU per day). High-resolution peripheral quantitative CT (HR-pQCT) was used in fracture assessment. The high-dose group had a decreased trabecular number (p < 0.01) and lower compression stiffness (p < 0.05) compared with the control group. The authors concluded that low-dose vitamin D did not enhance fracture healing, and high-dose vitamin D “may be detrimental in restoring bone stiffness during the first 12 weeks of fracture healing.” 

Bisphosphonates 

– Researchers analyzed the 10-year data of patients who received bisphosphonate treatment². The main outcome was the risk of atypical femoral fracture. Among 196,129 women included in the analysis, a total of 277 atypical femoral fractures occurred. The absolute risk of atypical fracture remained low compared with reductions in the risk of hip and other fractures following bisphosphonate treatment. Risk increased with longer duration of treatment. Asian patients compared with White patients had a higher risk of developing atypical femoral fractures. Short stature and higher weight were other risk factors. 

Romosozumab  

– In the Active-Controlled Fracture Study in Postmenopausal Women with Osteoporosis at High Risk (ARCH), investigators examined the effectiveness of treatment with romosozumab followed by alendronate vs. alendronate treatment alone in reducing the risk of additional fractures in patients who had experienced a fragility fracture³. The researchers found a 48% reduction in vertebral fractures, a 38% reduction in hip fractures, and a 19% reduction in nonvertebral fractures favoring the romosozumab group. 

Teriparatide  

– The Osteosarcoma Surveillance Study was launched in 2003 to monitor a potential association between the osteoporosis treatment teriparatide and osteosarcoma. Investigators found that the incidence of osteosarcoma associated with teriparatide did not differ from the background incidence rate⁴. 

– A randomized, multicenter, double-blinded study evaluated the use of teriparatide and distal fracture healing⁵. Among 102 postmenopausal women treated with reduction and casting for a distal radial fracture, those treated for 8 weeks with a daily 20-µg dose of teriparatide had a significantly faster time to radiographic union than those treated with placebo (7.4 vs. 9.1 weeks). However, the investigators found that twice the typical dose (40 µg) demonstrated no benefit over placebo. 

“What’s New in Osteoporosis and Fragility Fractures” is freely available at JBJS.org. 

What’s New by Subspecialty 

Each month, JBJS publishes a review of the most pertinent studies from the orthopaedic literature in a select subspecialty. To read the reports, visit the “What’s New by Subspecialty” collection at JBJS.org. 

Recent OrthoBuzz posts include: “What’s New in Limb Lengthening and Deformity Correction,” What’s New in Orthopaedic Trauma,” and “What’s New in Spine Surgery.”  

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References 

1. Heyer FL, de Jong JJ, Willems PC, Arts JJ, Bours SGP, van Kuijk SMJ, Bons JAP, Poeze M, Geusens PP, van Rietbergen B, van den Bergh JP. The effect of bolus vitamin D3 supplementation on distal radius fracture healing: a randomized controlled trial using HR-pQCT. J Bone Miner Res. 2021 Aug;36(8):1492-501. 
2. Black DM, Geiger EJ, Eastell R, Vittinghoff E, Li BH, Ryan DS, Dell RM, Adams AL. Atypical femur fracture risk versus fragility fracture prevention with bisphosphonates. N Engl J Med. 2020 Aug 20;383(8):743-53. 
3. Saag KG, Petersen J, Brandi ML, Karaplis AC, Lorentzon M, Thomas T, Maddox J, Fan M, Meisner PD, Grauer A. Romosozumab or alendronate for fracture prevention in women with osteoporosis. N Engl J Med. 2017 Oct 12;377(15):1417-27.  
4. Gilsenan A, Midkiff K, Harris D, Kellier-Steele N, McSorley D, Andrews EB. Teriparatide did not increase adult osteosarcoma incidence in a 15-year US Postmarketing Surveillance Study. J Bone Miner Res. 2021 Feb;36(2):244-51.  
5. Aspenberg P, Genant HK, Johansson T, Nino AJ, See K, Krohn K, García-Hernández PA, Recknor CP, Einhorn TA, Dalsky GP, Mitlak BH, Fierlinger A, Lakshmanan MC. Teriparatide for acceleration of fracture repair in humans: a prospective, randomized, double-blind study of 102 postmenopausal women with distal radial fractures. J Bone Miner Res. 2010 Feb;25(2):404-14.