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Impact of Bone Mineral Density-Modulating Medications on Complications Following Distal Radius Fracture Fixation: A Multi-Institutional Cohort Study
Jad Lawand, MS
1, Josh Wang, BS
2, Katherine S. Ferry, MD
1, Umar M. Ghilzai, MD
3; John Faillace, MD
1(1)University of Texas Medical Branch, Galveston, TX, (2)University of Texas Medical Branch, League City, TX, (3)Baylor College of Medicine, Houston, TX
Introduction:
Medications that impair bone remodeling may adversely affect fracture healing. This study evaluated the association between bone mineral density (BMD)-modulating medications and postoperative complications after distal radius fracture (DRF) fixation.
Methods:
A retrospective cohort study was conducted using the TriNetX Research Network. Adults undergoing surgical fixation for DRF (CPT codes 25607-25609) between 2000 and 2022 were included if they had ?2 years of follow-up. Patients were stratified by exposure to BMD-reducing medications-SSRIs, antiepileptics (AEDs), glucocorticoids (with calcineurin inhibitors), proton pump inhibitors (PPIs), thiazolidinedione-hydrochlorothiazide (TZD-HCTZ), and antipsychotics (SGA-FGA)-prescribed within 6 months before or after surgery. Propensity score matching controlled for demographics and comorbidities. Outcomes included malunion, nonunion, and surgical repair of malunion/nonunion. Risk ratios (RR) and 95% confidence intervals (CI) were calculated.
Results:
Each drug class was analyzed in a separate matched cohort (range: 3,923 to 21,542 patients per group). AED use was associated with the highest risk of nonunion (RR 3.45, 95% CI 2.10-5.68,
p<0.001) and increased surgical repair (RR 1.93, 95% CI 1.45-2.58,
p<0.001). SSRIs increased the risk of repair for malunion/nonunion (RR 1.84, 95% CI 1.24-2.73,
p=0.002). Glucocorticoids were associated with greater risk of malunion (RR 1.84, 95% CI 1.27-2.67,
p=0.001) and nonunion (RR 1.79, 95% CI 1.20-2.67,
p=0.004). PPIs were associated with higher surgical repair risk (RR 1.45, 95% CI 1.04-2.02,
p=0.029). No significant differences were found for TZD-HCTZ or antipsychotic use across any primary outcomes.
Conclusion:
Use of AEDs, SSRIs, glucocorticoids, and PPIs around the time of DRF surgery is associated with increased rates of malunion, nonunion, and surgical revision, with the highest risk linked to antiepileptic use. These findings underscore the importance of medication review when planning operative fracture care.
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