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Oversuppression of bone turnover with <jats:styled-content style=\"fixed-case\">BP<\/jats:styled-content>s may paradoxically limit the reserve capacity of bone to heal. The aim of this review was to study the predisposition of some patients to delayed\/non\u2010union of upper limb fractures associated with <jats:styled-content style=\"fixed-case\">BP<\/jats:styled-content>s and give recommendations on how they should be treated.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A systematic search of two electronic databases was conducted to identify relevant studies for inclusion. All relevant studies found were included and assessed through methodology criteria predetermined by two independent reviewers.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Six papers comprising of three case reports, one nested case control study, one restrospective review and one randomized clinical trial were used. In comparative studies of pre\u2010fracture <jats:styled-content style=\"fixed-case\">BP<\/jats:styled-content> use, a 6\u2010day delay in average healing times was reported among <jats:styled-content style=\"fixed-case\">BP<\/jats:styled-content> users. There was no elevation in risk of non\u2010union. Post\u2010fracture <jats:styled-content style=\"fixed-case\">BP<\/jats:styled-content> use was associated with an approximate doubling of the risk of non\u2010union. Timing of <jats:styled-content style=\"fixed-case\">BP<\/jats:styled-content> therapy initiation following a fracture was not associated with a difference in healing times. An atypical ulna fracture treated conservatively resulted in non\u2010union, there was no effect of type of surgical treatment on distal radius fracture healing and there was insufficient evidence to comment on humeral fracture treatment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Differences in union time between <jats:styled-content style=\"fixed-case\">BP<\/jats:styled-content> users and non\u2010users are not significant enough to change current practice patterns and do not outweigh the benefits of <jats:styled-content style=\"fixed-case\">BP<\/jats:styled-content> therapy. There is no evidence to encourage early surgical management of <jats:styled-content style=\"fixed-case\">BP<\/jats:styled-content>\u2010related upper limb fractures.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ans.12536","type":"journal-article","created":{"date-parts":[[2014,2,17]],"date-time":"2014-02-17T12:12:15Z","timestamp":1392639135000},"page":"218-224","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":21,"title":["Delayed\/non\u2010union of upper limb fractures with bisphosphonates: systematic review and recommendations"],"prefix":"10.1111","volume":"84","author":[{"given":"Andrew Jin\u2010Hean","family":"Ng","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery Royal Melbourne Hospital University of Melbourne  Melbourne Victoria Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brian","family":"Yue","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery Royal Melbourne Hospital University of Melbourne  Melbourne Victoria Australia"},{"name":"Department of Plastic and Reconstructive Surgery Royal Melbourne Hospital University of Melbourne  Melbourne Victoria Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Samuel","family":"Joseph","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery Royal Melbourne Hospital University of Melbourne  Melbourne Victoria Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martin","family":"Richardson","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery Royal Melbourne Hospital University of Melbourne  Melbourne Victoria Australia"},{"name":"Department of Orthopaedic Surgery Epworth Hospital  Melbourne Victoria Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2014,2,17]]},"reference":[{"key":"e_1_2_5_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bone.2010.05.019"},{"key":"e_1_2_5_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2265.2009.03581.x"},{"key":"e_1_2_5_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11999-010-1583-2"},{"key":"e_1_2_5_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0b013e31821957e3"},{"key":"e_1_2_5_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11999-011-1828-8"},{"key":"e_1_2_5_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11999-011-2194-2"},{"key":"e_1_2_5_8_1","unstructured":"United States Food and Drug Administration.Background Document for Meeting of Advisory Committee for Reproductive Health Drugs and Drug Safety and Risk Management. 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