title: Impaired healing of fragility fractures in type 2 diabetes: clinical and radiographic assessments and serum cytokine levels.
abstract: BACKGROUND
  Diabetes induces bone alterations accompanied by altered cytokine expression patterns. These alterations lead to modified fracture healing, contributing to musculoskeletal fragility in the elderly.
  
  
  OBJECTIVE
  We evaluated the inflammatory immune response in diabetic patients during fracture healing relative to clinical and radiographic assessments.
  
  
  METHODS
  Fifty patients of both sexes with fragility fractures were studied: 30 diabetics (group A, mean age 73.4 ± 11.2 years) and 20 normoglycemic controls (group B, mean age 75.1 ± 16.9 years). Two subgroups comprised those with hip or wrist fragility fractures (25 and 16 patients, respectively). We evaluated serum concentrations of tumor necrosis factor α, interleukins 4 and 8, monocyte chemotactic protein-1 (MCP-1), vascular endothelial growth factor, and epidermal growth factor (EGF) before and at 4 and 8 weeks after surgery. We also determined the Radiographic Union Score for Hips and the Radius Union Scoring System score and applied the Physical Activity Scale for the Elderly test at the same time points. Each patient underwent bone densitometry.
  
  
  RESULTS
  MCP-1 and EGF levels were higher in group A than in group B at 4 weeks after surgery (p > 0.05). Radiographic evaluation showed lower scores in group A (p < 0.05). The main difference between the groups was evident 4 weeks after surgery. Changes in the serum concentrations of chemotactic and angiogenic factors could explain the radiographically proved impaired fracture healing in diabetic patients.
  
  
  CONCLUSIONS
  Fragility fracture healing is impaired in diabetic patients. Radiographic and molecular patterns confirmed that the most compromised fracture-healing phase is at 4 weeks after surgery, during callus mineralization.
authors.affiliation: Graduate School of Orthopaedics and Traumatology, University of Rome Tor Vergata, Policlinico Tor Vergata Foundation, 81 Viale Oxford, 00133, Rome, Italy. fede.liuni@gmail.com.
authors.forename: Federico Maria
authors.initials: FM
authors.lastname: Liuni
authors.affiliation: Department of Orthopaedics and Traumatology, University of Rome Tor Vergata, Policlinico Tor Vergata Foundation, Rome, Italy.
authors.forename: Clelia
authors.initials: C
authors.lastname: Rugiero
authors.affiliation: Graduate School of Orthopaedics and Traumatology, University of Rome Tor Vergata, Policlinico Tor Vergata Foundation, 81 Viale Oxford, 00133, Rome, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Feola
authors.affiliation: Graduate School of Orthopaedics and Traumatology, University of Rome Tor Vergata, Policlinico Tor Vergata Foundation, 81 Viale Oxford, 00133, Rome, Italy.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Rao
authors.affiliation: Department of Orthopaedics and Traumatology, University of Rome Tor Vergata, Policlinico Tor Vergata Foundation, Rome, Italy.
authors.forename: Pietro
authors.initials: P
authors.lastname: Pistillo
authors.affiliation: Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Terracciano
authors.affiliation: Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, Rome, Italy.
authors.forename: Maria Gabriella
authors.initials: MG
authors.lastname: Giganti
authors.affiliation: Department of Orthopaedics and Traumatology, University of Rome Tor Vergata, Policlinico Tor Vergata Foundation, Rome, Italy.
authors.forename: Umberto
authors.initials: U
authors.lastname: Tarantino
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D018932:Chemokine CCL2 / Q000097:blood; D016207:Cytokines / Q000097:blood*; D003720:Densitometry / Q000379:methods; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000276:immunology; D005260:Female; D005592:Fracture Fixation / Q000009:adverse effects / Q000379:methods; D017102:Fracture Healing / Q000276:immunology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D058866:Osteoporotic Fractures / Q000000981:diagnostic imaging / Q000276:immunology*; D011184:Postoperative Period; D011859:Radiography; D011885:Radius Fractures / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D014409:Tumor Necrosis Factor-alpha / Q000097:blood; D042461:Vascular Endothelial Growth Factor A / Q000097:blood
chemical_list: C111835:CCL2 protein, human; D018932:Chemokine CCL2; D016207:Cytokines; D014409:Tumor Necrosis Factor-alpha; D042461:Vascular Endothelial Growth Factor A
keywords: Cytokines; Diabetes; Elderly; Fragility fracture; Inflammation