Advances and Promises of Nutritional Influences on Natural Bone Repair

Abstract

Impaired fracture healing continues to be a significant public health issue. This is more frequently observed in aging populations and patients with co‐morbidities that can directly influence bone repair. Tremendous progress has been made in the development of biologics to enhance and accelerate the healing process; however, side‐effects persist that can cause significant discomfort and tissue damage. This has been the impetus for the development of safe and natural strategies to hasten natural bone healing. Of the many possible approaches, nutrition represents a safe, affordable, and non‐invasive strategy to positively influence each phase of fracture repair. However, our understanding of how healing can be hindered by malnutrition or enhanced with nutritional supplementation has lagged behind the advancements in both surgical management and the knowledge of molecular and cellular drivers of skeletal fracture repair. This review serves to bridge this knowledge gap as well as define the importance of nutrition during fracture healing. The extant literature clearly indicates that pre‐existing nutritional deficiencies should be corrected, and nutritional status should be carefully monitored to prevent the development of malnutrition for the best possible healing outcome. It remains unclear, however, whether the provision of nutrients beyond sufficiency has any benefit on fracture repair and patient outcomes. The combined body of pre‐clinical studies using a variety of animal models suggests a promising role of nutrition as an adjuvant therapy to facilitate fracture repair, but extensive research is needed, specifically at the clinical level, to clarify the utility of nutritional interventions in orthopedics. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:695‐707, 2020

Nutrition and Vitamin Deficiencies Are Common in Orthopaedic Trauma Patients

“…Almost half of the patients (48.5%) were deficient in transferrin, which also indicates significant malnutrition [ 24 ] and has been implicated in wound complications in arthroplasty [ 25 ]. Regarding micronutrient deficiencies, we found substantial deficiencies in vitamins A, C, D, and zinc, which is in line with the data available in the geriatric population [ 11 , 14 ]. In addition, Hispanic patients were also much more likely to be vitamin D deficient.…”

“…Previous studies demonstrated improved outcomes with nutritional supplements in the geriatric population [ 14 , 20 ] and enhanced callus formation with zinc supplementation in young adult trauma patients with lower extremity fractures [ 21 ]. To our knowledge, there have not been any data reported on nutritional deficiencies using multiple serum markers in orthopaedic trauma patients with injuries at high risk for infection.…”

“…Additionally, albumin deficiencies have been shown to correlate with wound complications in patients undergoing joint replacement surgery [ 9 ] and readmission rates for patients undergoing elective spine surgeries [ 10 ]. However, prior research has mostly focused on the geriatric populations, elective orthopaedic surgeries, and albumin and prealbumin as serum markers for malnutrition [ 11 , 12 , 13 , 14 ].…”

Bifidobacterium adolescentis supplementation attenuates fracture-induced systemic sequelae

“…These fractures primarily heal through secondary bone healing, which largely progresses through endochondral ossification. Secondary bone healing is a well-orchestrated series of overlapping events that is initiated by an initial reactive inflammatory stage [ 1 – 4 ]. The local inflammatory environment is critically important for the synthesis of matrix, recruitment of mesenchymal stem cells, and vascularization of the callus [ 1 , 5 ].…”

The effects of romosozumab combined with active vitamin D 3 on fracture healing in ovariectomized rats

“…Because reducing osteoclast activity can lead to hypocalcemia, the administration of active vitamin D 3 is essential. It remains unknown whether active vitamin D 3 administration in an OVX fracture model is effective for fracture healing [10] [11].…”