What are the treatment options for osteoporosis in hip fractures using bisphosphonate (Bisphosphonate)?

From the Guidelines

Bisphosphonates are the recommended treatment for osteoporosis in patients with hip fractures to reduce the risk of subsequent fractures, with zoledronic acid 5mg IV once yearly being a preferred option, as evidenced by high-quality studies 1. The treatment of osteoporosis in patients with hip fractures is crucial to prevent subsequent fractures and improve quality of life.

Key Considerations

• The preferred bisphosphonate options include zoledronic acid, alendronate, and risedronate, which have been shown to reduce the risk of vertebral, non-vertebral, and hip fractures 1.
• Zoledronic acid can be initiated within 90 days post-surgery, while oral alternatives such as alendronate 70mg weekly, risedronate 35mg weekly, or ibandronate 150mg monthly can be used for patients who cannot tolerate intravenous therapy 1.
• Treatment should continue for 3-5 years initially, with reassessment afterward to determine the need for ongoing therapy 1.
• All patients should receive calcium supplementation (1000-1200mg daily) and vitamin D (800-1000 IU daily) alongside bisphosphonates to support bone health 1.
• Prior to starting therapy, dental evaluation is recommended to minimize the risk of osteonecrosis of the jaw, and kidney function should be assessed as bisphosphonates require dose adjustment or avoidance in severe renal impairment 1.

Alternative Options

• For patients unable to tolerate bisphosphonates, alternative medications like denosumab or teriparatide may be considered, as they have also been shown to reduce fracture risk 1.
• The choice of alternative therapy should be based on individual patient factors, such as renal function, dental health, and tolerance to therapy 1.

Monitoring and Follow-up

• Regular monitoring of patients on bisphosphonate therapy is essential to assess tolerance, adherence, and efficacy of treatment 1.
• A systematic follow-up plan, including risk communication and shared decision making, can help improve adherence to therapy and reduce the risk of subsequent fractures 1.

From the FDA Drug Label

Risedronate sodium is a bisphosphonate in a delayed-release formulation and is indicated for treatment of postmenopausal osteoporosis (1.1) The answer to the question about osteoporosis treatment options in hip fracture using bisphosphonate is that Risedronate sodium is indicated for the treatment of postmenopausal osteoporosis. However, the label does not specifically mention hip fracture as an indication.

• The dosage for Risedronate sodium is one 35 mg delayed-release tablet once-a-week.
• Key warnings include upper gastrointestinal adverse reactions, hypocalcemia, osteonecrosis of the jaw, and severe bone, joint, muscle pain. 2

From the Research

Osteoporosis Treatment Options in Hip Fracture Using Bisphosphonate

• Bisphosphonates are a class of medications commonly used to treat osteoporosis, particularly in patients with a history of hip fracture 3, 4, 5.
• A study published in 2006 found that only 5 patients out of 174 had previously been prescribed a bisphosphonate before being admitted to a hip fracture rehabilitation program 3.
• The same study found that all patients were prescribed 2500 mg calcium, 400 IU vitamin D, and 5 mg residronate daily during rehabilitation and at discharge, and that 71 patients remained on residronate therapy at 12 months 3.
• Another study published in 2014 discussed the antifracture effects and side-effects of antiresorptive drugs, including bisphosphonates, and found that vertebral, nonvertebral (including hip fracture) prevention with these drugs exceeds the risk of rare side-effects 4.
• A 2022 study highlighted the importance of individualizing osteoporosis treatment, including the selection of bisphosphonates, based on factors such as underlying fracture risk, medical comorbidities, and medication burden 5.

Efficacy and Safety of Bisphosphonates

• Bisphosphonates have been shown to be effective in reducing the risk of fracture in patients with osteoporosis, including those with a history of hip fracture 3, 4.
• However, bisphosphonates can also have rare side-effects, such as atypical femur fracture and osteonecrosis of the jaw 4.
• A study published in 2010 found that rates of in-hospital initiation of osteoporosis treatment, including bisphosphonates, were low in patients hospitalized for hip fractures 6.

Combination Therapy with Calcium and Vitamin D

• Calcium and vitamin D intake are essential for osteoporosis treatment, and bisphosphonates are often prescribed in combination with these supplements 3, 7, 6.
• A study published in 2013 found that rapid substitution therapy with high-dose oral cholecalciferol (vitamin D3) increased vitamin D plasma levels rapidly and safely in patients with hip fractures 7.
• Another study published in 2010 found that only 6.6% of patients hospitalized for hip fractures received calcium and vitamin D supplements, and that treatment rates remained low across virtually all patient-, provider-, and hospital-level characteristics 6.