{'fraction_non_alphanumeric': 0.019856358259400086, 'fraction_numerical': 0.007182087029995775, 'mean_word_length': 5.215223097112861, 'pattern_counts': {'":': 0, '<': 0, '<?xml version=': 0, '>': 0, 'https://': 0, 'lorem ipsum': 0, 'www.': 0, 'xml': 0}, 'pii_count': 0, 'substrings_counts': 0, 'word_list_counts': {'cursed_substrings.json': 0, 'profanity_word_list.json': 0, 'sexual_word_list.json': 0, 'zh_pornsignals.json': 0}}
Early Alendronate Can Be Safe during Fracture Healing?

I read the article by Duckworth and colleagues with great interest, especially as the JBMR June 2019 cover highlights “Alendronate Safe During Fracture Healing.” The study shows that early use of alendronate, starting around 10 days after fracture, does not affect healing at 2, 4, 6, and 8 weeks and presumably also at 24 weeks. Malunion after a wrist fracture was determined by “measuring dorsal angle, carpal alignment, and radial shortening and was declared to exist when there was carpal malalignment with less than neutral dorsal tilt and/or more than 3 mm of radial shortening.” The clinical DASH index was recorded, but bone strength was not assessed. Also, bone turnover markers were not measured, even though they can be informative, as they are expected to be elevated during the healing process. Even though bisphosphonates are likely to accumulate rapidly at fracture sites, their antiresorptive effect may not be maximal until 3 months of treatment. The authors rightfully stated that they cannot determine the long-term effect of bisphosphonate therapy on bone healing because the trial did not go beyond 26 weeks. Likewise, patients who started on treatment within 2 years of fracture were excluded from the study. Previous studies, however, have shown that fracture healing was delayed in current bisphosphonate users compared with naïve patients. The reasons for starting a bisphosphonate before healing is complete is to prevent early additional fractures, which can occur after a vertebral fracture. However, such early secondary fractures are less likely to occur in long bones, if not associated with obvious risks for falling. Furthermore, a recent study showed bisphosphonates have little effect on healing new fracture after suffering an acute osteoporotic spine fracture compared with placebo. Therefore, based on the available evidence, it would seem prudent to delay antiresorptive therapy with bisphosphonates or at least withhold the current treatment until there is radiographic evidence of fracture healing to avoid reducing bone remodeling and thus conversion of soft callus to solid bone. Because of this, the cover page highlight probably should read “Early Alendronate Can Be Safe During Fracture Healing,” as this is the only conclusion supported by evidence in the article.