Abstract
IntroductionAnimal models indicate that osteoporosis may negatively influence the fracture healing process, but clinical studies on this topic are scarce. In this study we investigated the effect of osteoporosis on fracture healing in patients with an upper extremity fracture. MethodsThis retrospective cohort study included all patients aged 50 years or older, with a fracture of the proximal humerus or the distal radius treated in the period June 2012 to July 2015 and a DEXA scan within a year after fracture. The incidence of delayed-union and non-union were compared between patients with or without osteoporosis (BMD T score ≤ −2.5SD). A secondary analysis was performed with a more pragmatically definition; BMD T score ≤ −2.5SD or a proximal humerus fracture with a T-score between −2.5SD and −1.0SD. ResultsOsteoporosis was diagnosed in 133/455 patients (29.2%). A total of 461 fractures (distal radius n = 311 and proximal humerus n = 150) were treated. Radiological delayed- or non-union was described in 11/461 cases (2.4%); all proximal humerus fractures of which 6 cases (1.3%) were clinically manifest. The incidence of delayed- or non-union in fracture treatment did not differ between patients with osteoporosis (5/137 fractures) and the patients without osteoporosis (6/324 fractures) (p = 0.27). In the second analysis a significantly higher incidence was found in patients with osteoporosis (10/214 fractures vs 1/247 fractures p = 0.003) ConclusionsThe results of this study suggest that osteoporosis does not significantly influence the progress of fracture healing in distal radius and proximal humerus fractures, although there seems to be a tendency towards a negative effect.
Highlights
Animal models indicate that osteoporosis may negatively influence the fracture healing process, but clinical studies on this topic are scarce
The results of the Dual Energy X-ray Absorptiometry (DEXA) scan did not differ between the group of patients in which the scan was performed within 8 weeks compared to the group with a scan made after 8 weeks (p = 0.07)
This study retrospectively investigated the effect of osteoporosis on fracture healing in a 455 patients of 50 years and older with 461 proximal humerus or distal radius fractures
Summary
Animal models indicate that osteoporosis may negatively influence the fracture healing process, but clinical studies on this topic are scarce. In the second analysis a significantly higher incidence was found in patients with osteoporosis (10/214 fractures vs 1/247 fractures p = 0.003) Conclusions: The results of this study suggest that osteoporosis does not significantly influence the progress of fracture healing in distal radius and proximal humerus fractures, there seems to be a tendency towards a negative effect. Mechanical and biological factors that are involved in the complex process of fracture healing seem to be affected negatively by osteoporosis.[1,5] These effects of osteoporosis have mainly been studied in animal models of postmenopausal osteoporosis.[1,6,7,8] Studies showed reduced bone mass and mechanical strength[8] of the bone after completion of healing,[5,8] and fracture healing appeared to be delayed[6,8] with respect to callus mineralization. The bone stimulating drug Teriparatide, a recombinant parathyroid hormone analogue, appears to have a positive effect on fracture healing time.[12,13]
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