Clinical evaluation of medicinal products for acceleration of fracture healing in patients with osteoporosis

Goldhahn, Jörg; Scheele, Wim H.; Mitlak, Bruce; Abadie, Eric; Aspenberg, Per; Augat, Peter; Brandi, Maria Luisa; Burlet, Nansa; Chines, Arkadi; Delmas, Pierre D.; Dupin-Roger, Isabelle; Ethgen, D; Hanson, Beate; Hartl, Florian; Kanis, John А.; Kewalramani, Reshma; Laslop, Andrea; Marsh, David; Ormarsdóttir, Sif; Rizzoli, René; Santora, A.; Schmidmaier, Gerhard; Wagener, Michael; Reginster, Jean‐Yves

doi:10.1016/j.bone.2008.04.017

Cited by 50 publications

(42 citation statements)

References 16 publications

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“…The issue of bone repair has been the subject of two previous reports from the Group for the Respect of Ethics and Excellence in Science (GREES) and the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) [6,7]. The first paper identified critical issues for clinical trials in fracture healing [6] and called for guidelines for trials designed to demonstrate positive or negative impacts of agents on fracture healing.…”

mentioning

confidence: 98%

Implications for Fracture Healing of Current and New Osteoporosis Treatments: An ESCEO Consensus Paper

et al. 2012

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mentioning

confidence: 98%

Implications for Fracture Healing of Current and New Osteoporosis Treatments: An ESCEO Consensus Paper

et al. 2012

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“…There is as yet no clear evidence that a delay in fracture healing occurs in humans with osteoporosis; that is to say, no study has yet produced evidence on this aspect [12,13,15]. On the other hand, compared to normal bone, there is a twofold larger complication rate in fragility fracture repair.…”

Section: Do Fragility Fractures Heal Differently?mentioning

confidence: 91%

“…Biological repair, which depends on local stem cell and cell migration, and mechanical circumstances in the fracture fragments, are both of vital importance. Good overviews of fracture healing in osteoporotic bone are provided by Goldhahn et al, Novicoff et al, and Jacob et al [12][13][14].…”

Section: Do Fragility Fractures Heal Differently?mentioning

confidence: 99%

Current Aspects of Fragility Fracture Repair

Grote

Boecker²,

Mutschler³

et al. 2008

Eur J Trauma Emerg Surg

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Due to the demographic developments worldwide, fragility fractures represent an increasing problem for the public health system. The risk of developing osteoporosis increases with age and is relatively higher in women and in the Caucasian population. The stability of bone is reduced because of accentuation of the normal loss of bone mass in ageing, leading to an increased susceptibility to fracture with an increased rate of complications after surgical stabilization. Due to this, the orthopedic surgeon has to assess the quality of the bone during preoperative planning and select the implants and postoperative care accordingly to achieve the best. Over the last 10 years fixed locking implants have been introduced into clinical practice. These represent a new type of angle stable fixation devices that address the mechanical instability between bone and implant. The novel problems associated with this device are due to higher cut-out rates when the bone structure is altered and mass is reduced. The developments in joint replacement have also resulted in longer standing times and lower complication rates with immediate fullweight-bearing after implantation. However, to date, little is known about the mechanisms of fracture healing in osteoporosis or fragility fractures. One future approach may be in supporting biological fracture healing by regenerative therapies using growth hormones and/or (stem) cells. The most frequent initial clinical symptom of osteoporosis is a fracture without a relevant trauma. At this stage, the trauma surgeon should initiate diagnostic procedures, treatment of osteoporosis and tertiary prevention according to the European guidelines. Ultimately, all female patients older than 50 years and all male patients older than 60 years with fractures should be assessed and treated for bone quality. Orthogeriatric specialists or interdisciplinary orthogeriatric teams should initiate a specific surgical treatment followed by early rehabilitation in order to allow the elderly patient to return to daily living as soon as possible.

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“…Biomaterials with the potential to stimulate bone healing have gained interest to improve healing and outcome for patients with osteoporotic fractures [54].…”

Section: Biomaterials For Osteoporotic Fracturesmentioning

confidence: 99%

Biomaterials for enhancement of bone healing in osteoporotic fractures

Thormann¹,

Ray

Sommer

et al. 2013

BioNanoMaterials

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Osteoporosis and osteoporotic fractures have a high impact on the quality of life of patients and on the financial aspects of Western health care systems. There is a tremendous need for improvement of the treatment outcome in osteoporotic fracture patients and biomaterials are of interest to stimulate fracture healing in those patients. For adequate characterization of biomaterials for the indication of osteoporotic fractures a clinically relevant animal model with a fracture defect in the metaphyseal region of a long bone in an osteoporotic animal is required. We recently developed a 3-5 mm wedge shaped osteotomy model in the distal metaphysis of the femur in osteoporotic rats. There are different biomaterials approaches to stimulate fracture healing in osteoporotic fractures and recently published results suggest that the composite implants from osteoconductive carriers combined with osteoanabolic agents, e.g., strontium-modified calcium phosphate cement, can enhance new bone formation. Further in vivo and clinical research will be necessary in the future for introduction of new and different types of biomaterials for osteoporotic fracture patients into all day clinical practice.

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Clinical evaluation of medicinal products for acceleration of fracture healing in patients with osteoporosis

Cited by 50 publications

References 16 publications

Implications for Fracture Healing of Current and New Osteoporosis Treatments: An ESCEO Consensus Paper

Implications for Fracture Healing of Current and New Osteoporosis Treatments: An ESCEO Consensus Paper

Current Aspects of Fragility Fracture Repair

Biomaterials for enhancement of bone healing in osteoporotic fractures

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