A review on interventions to prevent osteoporosis and improve fracture healing in osteoporotic patients

Abstract

Introduction Proportion of aged people has increased due to improvement in longevity. With advancing age bones loose mass, get weakened, become more prone to osteoporotic fractures. Development of osteoporosis is silent with reduction in total bone mineral content. Bone mineral density is the most important parameter which can measure gravity of OP. The T-score of −2.5 or below indicates OP leading to fractures commonly in bones of spine, hip and distal extremities. Objective Purpose of this review is to find out currently available as well as future approaches those could be beneficial in faster recoveries. Method Major databases were searched from inception to till January 2020. Relevant main articles and cross references were evaluated. In addition, findings were compared to a previously published review. Pharmacological and bio-molecule interventions decrease bone depletion by reducing bone resorption and enhancing bone formation process, and other external stimuli like strengthening muscular and skeletal tissues are employed to prevent OP and accelerate fracture healing and normal functioning. Results A literature review of such interventions showed that bisphosphonates and selective estrogen receptor modulator treatment reduces fracture risks in osteoporosis and increase callus formation during fracture repair but do not reduce total time of fracture healing. Parathyroid hormone (PTH) and its analogues prevent OP by promoting callus formation as well as osteogenesis, enhance coupled remodelling and amount of mineralized tissue. When PTH is combined with bone morphogenetic proteins (BMP) improve mechanical functioning by integrating new bone tissue with old bone tissue. Restraining and supportive therapies like the physical exercises could be beneficial to minimize gravity of osteoporosis. Electromagnetic field therapy and pulsed ultrasonic therapy could be useful after surgical management of fracture or delayed union. Conclusion To identify the quantitative effect of these therapies in isolation or in combination, clinical trials under proper experimental settings are especially important. Unlike the therapies for fracture repair in non-osteoporotic patients, the line of treatment and duration of each therapy in isolation or in combination with pharmacological agents, biomolecules, physical stimuli, exercises and lifestyles are necessary.