Influence of antiosteoporotic therapy on bone fracture consolidation processes: a systematic analysis of modern data

Background. Osteoporosis is a serious medical and social problem characterized by progressive bone loss and an increased risk of fractures. For a long time, there have been concerns in clinical practice about the negative impact of antiosteoporotic drugs on fracture healing processes, which has led to an unjustified delay in specific therapy in patients with recent injuries. Consolidation of fractures in osteoporosis occurs under conditions of an imbalance between bone resorption and bone formation, which creates the prerequisites for the formation of inadequate bone callus. The aim of the study is a systematic analysis of modern data on the effect of various groups of antiosteoporotic drugs on the processes of bone fracture consolidation in order to form an evidence base for optimizing therapeutic approaches. Research methods. A systematic search of scientific literature was conducted in the PubMed, Scopus, Web of Science, EMBASE and Cochrane Library databases for the period 2017–2025. Search queries included combinations of terms related to osteoporosis, fractures, and antiosteoporotic therapy. The analysis included randomized controlled trials, prospective and retrospective cohort studies, meta-analyses, and systematic reviews assessing the efficacy of bisphosphonates, denosumab, teriparatide, and calcium and vitamin D supplements in fracture healing. Study results. The analysis showed that antiosteoporotic drugs do not have a negative effect on fracture healing when the treatment regimen is selected correctly. Bisphosphonates, especially zoledronic acid, demonstrate a positive effect on bone microarchitecture and reduce the risk of recurrent fractures by 35 % while reducing mortality by 28 % after proximal femur fractures. Denosumab shows comparable efficacy and has advantages in patients with severe cortical bone loss. Teriparatide exhibits differential efficacy depending on the fracture location, accelerating the consolidation of intertrochanteric fractures, but not demonstrating significant advantages in medial femoral neck fractures. Calcium and vitamin D preparations are a necessary component of therapy, but require supplementation with specific antiosteoporotic agents. The effectiveness of therapy varies significantly depending on the type of fracture, patient age and concomitant diseases, which necessitates a personalized approach to treatment.