How soon after a fracture would it be safe to start anti-resorptive therapy?

This is an important question. There is no definitive answer, and there have been no clinical or preclinical studies that demonstrate delayed healing in the presence of bisphosphonates. Personally, I favor waiting a few weeks before we start. That also gives us time to do a proper metabolic workup. I am not a fan of IV bisphosphonates in the hospital at the time of hip fracture. I think there are theoretical reasons to not inhibit osteoclasts early on. Plus, acute phase reaction with IV bisphosp...

Great question. We favor starting bisphosphonates, if patients are eligible, as soon as possible after a fragility fracture. Patients with recent fragility fractures often experience significant difficulty in achieving timely and regular outpatient follow-up, and IV bisphosphonates during the inpatient period offer a great opportunity to bridge that gap. In our experience, we found IV zolendronic acid for hip fractures during the incident admission to be effective and safe.

Here are our reference...

Agree with Dr. @Dr. First Last. Inpatient is a great opportunity to infuse ZA into these patients, and they can be followed up as outpatients later on. However, most inpatient pharmacies do not carry ZA, and it is also debatable whether insurance will cover ZA infusion as an inpatient. So, though this is feasible as a research study, there are a lot of bureaucratic hurdles in actual practice for inpatient ZA infusion.