Effect of Anti-Osteoporotic Drugs in Prevention of Bone Fracture: A Scoping Review

Abstract

Introduction: Fragility fractures due to osteoporosis account for 9 million of the total fractures registered annually worldwide. Osteoporosis can be successfully treated with both antiresorptive and anabolic drugs, whose efficacy in reducing fracture incidence. Despite this, only a small proportion of osteoporotic patients are currently treated for fracture prevention. This scoping review describes how osteoporosis and various categories of anti-osteoporotic drugs impact fracture healing.
Methods: We performed a systematic search of the available literature in MEDLINE In-Process and Other Non-Indexed Citations Embase.com, and Cochrane Central Register of Controlled Trials. For each separate anti-osteoporotic agent PubMed was searched for evidence from randomized clinical trials (RCTs) in patients and animal studies with osteoporosis on anti-osteoporotic (antiresorptive). The main search was completed independently by four investigators. Criteria for inclusion/exclusion of studies were established prior to the literature search. Eligible for the systematic review were retrospective, observational prospective, and randomized controlled trials (RCTs), which investigated the efficacy of the anti-osteoporotic drugs on fracture risk BMD.
Results: Earlier studies that demonstrated the anti-osteoporotic effect of drugs had limited sample size and focused on single fracture type and/or a specific anti-osteoporotic treatment regimen . There are also no comprehensive reviews that present the effectiveness of the existing anti-osteoporotic drugs in use for patients with osteoporotic fractures. We found animal studies, preclinical and clinical trials, in addition to three reviews.

Conclusions: A consistent proportion of osteoporosis patients did not receive specific treatment after a fracture, showing poor adherence to national guidelines on osteoporosis treatment. Osteoporosis drug treatment, and to a greater extent in combination with calcium/vitamin D, and adherence were correlated with lower risk of both re-fracture and all-cause mortality.