Title: Pharmacologic Agents in Fracture Healing
Authors: Koester, MC MD, ATC; Spindler, KP MD
Source: Clinics in Sports Medicine 2006; 25: 69-73.
PODIATRIC RELEVANCE:
It is not uncommon for Podiatric physicians to treat athletic patients with traumatic fractures. Fractures treated by surgical intervention often allow for an earlier return to activity, however, it does not usually accelerate the bone healing process. This article discusses the potential role of pharmacologic agents in the treatment of sports related osseous injuries.
RESULTS:
This article is a literature review of the potential role for bisphosphonates, parathyroid hormone, vitamin D supplementation, and non-steroidal anti-inflammatory (NSAIDs) for the treatment of sports related fractures. Bisphosphonates have a marked inhibitory reaction to osteoclast mediated bone resorption and some studies suggest it may increase bone mineral density (BMD) which may help in fracture repair by enhancing the healing process and limiting disuse osteoporosis. However, the clinical relevance of increasing BMD within the fracture callous is uncertain. Since bisphosphonates possess an inhibitory osteoclastic effect, they may potentially have a prophylactic use in preventing stress fractures by suppressing initial bone turnover. Transient bone weakness associated with stress fractures may also be bypassed.
Parathyroid hormone (PTH) plays a significant role in both intra- and extra-cellular calcium homeostasis. PTH appears to have an effect secondary to the activation of resting osteoblasts which results in an increased number of circulating cells. PTH may not have a role in the treatment of non-unions because of the need for viable osteoblasts cells. However, it may play a role in the treatment of slowly resolving stress fractures.
Vitamin D and calcium are essential to building and maintaining healthy bones. Some animal studies have shown that treatment with Vitamin D and calcium increases the mechanical strength of the callous. In one study on osteoporotic women with acute humerus fracture, significant difference in bone callous formation was noted after 6 weeks of treatment. However, this finding was not sustained after 12 weeks.
Based on the current studies, no firm evidence-based recommendation can be made regarding the use of NSAIDs in the treatment of fracture. In theory, NSAIDs may delay bone healing which may be detrimental to an already compromised structure.
COMMENTS:
Although athletes may benefit from pharmaceutical agents that prevent stress fractures or speed the healing process of an acute stress fracture, there is no substitute for appropriate diet and training regimen. Once again there is no definitive evidence showing the efficacy of the pharmacological agents discussed. The authors suggest a need for further randomized clinical trials.
________________________________________________________________________________________
Disclaimer:
Scientific Abstract Monthly postings are submitted by podiatric surgical residents. The ideas presented are not the opinions of the American College of Foot and Ankle Surgeons (ACFAS), nor are they presented as facts. ACFAS presents this information without any warranty of any kind, expressed or implied, and is not liable for its accuracy nor for any loss or damage caused by the user's reliance on information obtained in these areas.