• Silvano Adami, Cesar Libanati, Steven Boonen, Steven R Cummings, Pei-Ran Ho, Andrea Wang, Ethel Siris, Joseph Lane, FREEDOM Fracture-Healing Writing Group, Jonathan D Adachi, Mohit Bhandari, Luiz de Gregorio, Nigel Gilchrist, George Lyritis, Gerd Möller, Santiago Palacios, Karel Pavelka, Resch Heinrich, Christian Roux, and Daniel Uebelhart.
• Faculty of Medicine & Surgery, University of Verona, P. le Scuro 10, 37134, Verona, Italy.
• J Bone Joint Surg Am. 2012 Dec 5; 94 (23): 2113-9.

BackgroundFracture is the major complication of osteoporosis, and it allows the identification of individuals needing medical intervention for osteoporosis. After nonvertebral fracture, patients often do not receive osteoporosis medical treatment despite evidence that this treatment reduces the risk of subsequent fracture. In this pre planned analysis of the results of the three-year, placebo-controlled FREEDOM trial, we evaluated the effect of denosumab administration on fracture-healing to address theoretical concerns related to initiating or continuing denosumab therapy in patients presenting with a nonvertebral fracture.MethodsPostmenopausal women aged sixty to ninety years with osteoporosis were randomized to receive 60 mg of denosumab (n = 3902) or a placebo (n = 3906) subcutaneously every six months for three years. Investigators reported complications associated with a fracture or its management and with fracture-healing for all nonvertebral fractures that occurred during the study. Delayed healing was defined as incomplete fracture-healing six months after the fracture.ResultsSix hundred and sixty-seven subjects (303 treated with denosumab and 364 who received a placebo) had a total of 851 nonvertebral fractures (386 in the denosumab group and 465 in the placebo group), including 199 fractures (seventy-nine in the denosumab group and 120 in the placebo group) that were treated surgically. Delayed healing was reported in seven subjects (two in the denosumab group and five in the placebo group), including one with subsequent nonunion (in the placebo group). Neither delayed healing nor nonunion was observed in any subject who had received denosumab within six weeks preceding or following the fracture. A complication associated with the fracture or intervention occurred in five subjects (2%) and twenty subjects (5%) in the denosumab and placebo groups,respectively (p = 0.009).ConclusionsDenosumab in a dose of 60 mg every six months does not seem to delay fracture-healing or contribute to other complications, even when it is administered at or near the time of the fracture.

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