• Bone Density & Structure Disorders
• Metabolic Bone Disease
• Orthopaedics Clinical Trials
• Metabolic Bone Disease

• Orthopaedics
• Bone Density & Structure Disorders
• Metabolic Bone Disease
• Orthopaedics Clinical Trials
• Metabolic Bone Disease

Emanuele Betti, MD, Università di Pisa, Livorno, Italy, presented results from a randomized trial demonstrating a reduction in subsequent fractures in patients with intertrochanteric fractures who were treated with risedronate and received follow-up care with quantitative ultrasound (QUS) to monitor the existing fracture and bone status.

As life expectancy increases, low energy hip fractures become an increasing public health problem due to the growing size of the elderly population. Osteoporotic fractures are therefore becoming a significant cause of morbidity and mortality worldwide.

Risedronate is an oral bisphosphonate that inhibits osteoclast-mediated bone resorption and modulates bone metabolism, and, in the treatment of osteoporosis, this agent can play an important role in prevention of bone fractures. Additionally, QUS represents a valuable predictor of fracture risk and can also be useful in the management of osteoporosis. Specifically, it can provide information about factors such as bone density, elasticity, microarchitecture that contribute to “bone quality”, and therefore has a role to play in monitoring the response to antiosteoporotic treatments.

Prof. Betti and colleagues conducted a randomized trial in the use of QUS to compare the differences in bone mineral density (BMD), bone quality, and the incidence of new low-energy fractures in patients with intertrochanteric fractures treated with risedronate or placebo.

The study involved 100 female patients who underwent short proximal femoral nail fixation for low-energy hip intertrochanteric fracture. Patients were randomized to receive either risedronate 75 mg (n=51) on 2 consecutive days each month, or placebo (n=49), and received follow-up screening for 1 year to compare differences in BMD between the two groups, and evaluate the incidence of low energy refractures. BMD was measured with QUS, which provided stiffness index derived from the measurement of speed of sound, and broadband ultrasound attenuation.

Patients included in the study were postmenopausal women who had not previously been managed with bisphosphonates, and were independently mobile. Exclusion criteria included diseases known to affect bone metabolism and other serious comorbidities.

At 1-year follow-up, there were significant differences between the two groups in the parameters measured by QUS. These differences correlated with improved bone strength and reduced incidence of low energy refracture (hip, vertebrae, wrist) in patients treated with risedronate, and then placed in a follow-up program to monitor both the current fracture and bone status (Table 1).

In addition to using best practice to treat current fractures in patients with osteoporosis, orthopedic surgeons must also effectively manage the disease to prevent new fractures. Prof. Betti therefore concluded that QUS imaging in patients with fractures enables evaluation of bone mass in this patient population, allowing for the provision of appropriate pharmacological agents as necessary to reduce the risk of new fractures.

• © 2014 MD Conference Express®