title: Fracture repair: general aspects and influence of osteoporosis and anti-osteoporosis treatment.
abstract: Bone differs from other tissues in its capacity to self-repair after a fracture. The low bone mass and structural deterioration of bone associated with osteoporosis increases the risk of fragility fracture compared with healthy individuals. The intention of this article is to review the complex process of fracture repair and essential requirements for a successful fracture healing response summarized as the "diamond concept" in terms of aging and osteoporosis. The current preclinical and clinical evidence for a beneficial or harmful influence of anti-osteoporosis medications such as bisphosphonates, parathyroid hormone (PTH), strontium ranelate and antibodies of Wnt-inhibiting signaling proteins on bone healing is presented and discussed. Literature suggests that there are no detrimental consequences of such therapeutics on fracture repair processes. Following a fragility fracture, it seems that early start of preventive anti-osteoporotic treatment right after surgery does not delay the union of the fracture, except perhaps in the case of very rigidly fixed fracture requiring direct bone healing. There is some promising experimental and clinical evidence for possible enhancement of the bone repair process via administration of systemic agents. Further well designed studies in humans are necessary to accumulate more evidence on the positive effects and to translate this knowledge into valid therapeutic applications.
authors.affiliation: Professor of Orthopaedic Surgery, Chair of the Orthopaedic and Trauma Department, Saint Antoine Hospital. UPMC-Sorbonne Universities, Paris, France. Electronic address: jean-marc.feron@aphp.fr.
authors.forename: Jean-Marc
authors.initials: JM
authors.lastname: Féron
authors.affiliation: Senior lecturer, Orthopaedic and Trauma Department, Saint Antoine Hospital. UPMC-Sorbonne Universities, Paris, France.
authors.forename: Raphaël
authors.initials: R
authors.lastname: Mauprivez
mesh_terms: D015519:Bone Density / Q000187:drug effects; D050071:Bone Density Conservation Agents / Q000627:therapeutic use; D019485:Bone Morphogenetic Proteins / Q000187:drug effects; D001842:Bone and Bones / Q000187:drug effects / Q000378:metabolism*; D002146:Bony Callus; D004164:Diphosphonates / Q000627:therapeutic use*; D017102:Fracture Healing / Q000187:drug effects; D006801:Humans; D010024:Osteoporosis / Q000503:physiopathology* / Q000517:prevention & control*; D058866:Osteoporotic Fractures / Q000378:metabolism / Q000473:pathology / Q000517:prevention & control*; D010281:Parathyroid Hormone / Q000378:metabolism
chemical_list: D050071:Bone Density Conservation Agents; D019485:Bone Morphogenetic Proteins; D004164:Diphosphonates; D010281:Parathyroid Hormone
keywords: Dikkopf-1; Wnt; bisphosphonates; diamond concept; fracture healing; osteoporosis; parathyroid hormone (PTH); sclerostin