Osteoporosis is not a risk factor for the development of nonunion: A cohort nested case–control study

Wunnik, B.P.W. van; Weijers, P.H.E.; Helden, Svenhjalmar van; Brink, Peter R.; Poeze, Martijn

doi:10.1016/j.injury.2011.08.019

Cited by 40 publications

(16 citation statements)

References 7 publications

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“…Our results concur with a prospective study of 1498 acute fracture patients over the age of 50 years who all underwent screening for osteoporosis and of whom 40 developed non-union (van Wunnik et al. 2011). After case-control matching (1:2), the authors concluded that osteoporosis was not a risk factor for fracture non-union.…”

Section: Discussionmentioning

confidence: 99%

The risk of non-union per fracture: current myths and revised figures from a population of over 4 million adults

2017

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Background and purposeFracture non-union remains a major clinical problem, yet there are no data available regarding the overall risk of fractures progressing to non-union in a large population. We investigated the rate of non-union per fracture in a large adult population.MethodsNational data collected prospectively over a 5-year period and involving just under 5,000 non-unions were analyzed and compared to the incidence of fracture in the same period.Results and interpretationThe overall risk of non-union per fracture was 1.9%, which is considerably less than previously believed. However, for certain fractures in specific age groups the risk of non-union rose to 9%. As expected, these higher rates of non-union were observed with tibial and clavicular fractures, but—less expectedly—it was in the young and middle-aged adults rather than in the older and elderly population. This study is the first to examine fracture non-union rates in a large population according to age and site, and provides more robust (and lower) estimates of non-union risk than those that are frequently quoted.

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Section: Discussionmentioning

confidence: 99%

The risk of non-union per fracture: current myths and revised figures from a population of over 4 million adults

2017

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“…Again osteoporosis was identified as an influencing factor [28] . In a matched case-control study, on prospective gathered data, of 40 patients with fracture non-union and 80 patients without a fracture non-union a regression analysis was performed to investigate whether the presence of osteoporosis attributed to the non-union, but did not detect any correlation [29] .…”

Section: Resultsmentioning

confidence: 99%

“…The study by Gorter et al [31] was retrospective, in which only in a small number of patients radiological follow up was available and the possible effect of osteoporosis treatment was not taken into account. More prospective studies like that of Van Wunnik et al [29] are needed in order to elucidate whether osteoporosis has a negative influence on fracture healing.…”

Section: Discussionmentioning

confidence: 99%

The effect of osteoporosis and its treatment on fracture healing a systematic review of animal and clinical studies

et al. 2021

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Introduction Osteoporosis is characterised by low bone mass and micro-architectural deterioration of bone structure. Its treatment is directed at the processes of bone formation or resorption, that are of utmost importance in fracture healing. We provide a comprehensive review of the literature aiming to summarize and clarify the effects of osteoporosis and its treatment on fracture healing. Material and methods A literature search was conducted in PubMed and Embase (OVID version). In vivo animal and human studies on long bone fractures were included. A total of 93 articles were included for this review; 23 studies on the effect of osteoporosis (18 animal and 5 clinical studies) and 70 studies on the effect of osteoporosis treatment (41 animal, 26 clinical studies and 3 meta-analyses) on fracture healing. Results In animal fracture models osteoporosis was associated with decreased callus formation and bone growth, bone mineral density, biomechanical strength and delayed cellular and differentiation processes during fracture healing. Two large databases identified osteoporosis as a risk factor for non-union whereas three other studies did not. One of those three studies however found a prolonged healing time in patients with osteoporosis. Anti-osteoporosis medication showed inconsistent effects on fracture healing in both non-osteoporotic and osteoporotic animal models. Only the parathyroid hormone and anti-resorption medication were related to improved fracture healing and delayed remodelling respectively. Clinical studies performed in predominantly hip and distal radius fracture patients showed no effect of bisphosphonates on fracture healing. Parathyroid hormone reduced time to union in several clinical trials performed in mainly hip fracture patients, but this did not result in decreased delayed or non-union rates. Conclusion Evidence that substantiates the negative influence of osteoporosis on fracture healing is predominantly from animal studies and to a lesser extent from clinical studies, since convincing clinical evidence lacks. Bisphosphonates and parathyroid hormone may be used during fracture healing, since no clear negative effect has been shown. Parathyroid hormone might even decrease time to fracture union, without decreasing union rate.

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“…In addition, one study positively found a signi cant correlation between osteoporosis and the risk of non-union [26], which is in line with the present study's ndings. However, another case-control study evaluated 1498 patients and failed to nd such an association [27].…”

Section: Resultsmentioning

confidence: 99%

Analysis of Risk Factors for Non-Union After Surgery for Limb Fractures: A Case-Control Study of 669 Subjects

Xu¹,

Zhang²,

Dai³

et al. 2020

Preprint

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Objective: Although a large number of clinical and animal experimental studies have explored factors affecting fracture healing, there are only a few examples of systematic research on these factors for limb fractures. The purpose of this study was to analyse the risk factors for limb fracture non-union in order to improve non-union prevention and early detection.Methods: A total of 223 patients with non-union after surgery for limb fractures performed at our institution from January 2005 to June 2017 were included as the case group, while a computer-generated random list was created to select 446 patients with successful bone healing who were treated during the same period as the control group, thus achieving a ratio of 1:2. The medical records of these patients were reviewed retrospectively. Age, sex, body mass index, obesity, smoking, alcohol, diabetes, hypertension, osteoporosis, fracture type, multiple fractures, non-steroidal anti-inflammatory drugs (NSAIDs) use, delayed weight bearing, internal fixation failure, and infection data were analysed and compared between the two groups. A multivariate logistic regression model was constructed to determine relevant factors associated with non-union.Results: The multivariate logistic regression analysis revealed that osteoporosis, open fractures, NSAIDs use, delayed weight bearing, failed internal fixation, and infection were independent risk factors for non-union after surgery for limb fractures.Conclusions: Osteoporosis, open fracture type, NSAIDs use, delayed weight bearing, failed internal fixation, and infection were found to be the main causes of bone non-union; clinicians should, therefore, take targeted measures to intervene in high-risk groups early.

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Osteoporosis is not a risk factor for the development of nonunion: A cohort nested case–control study

Cited by 40 publications

References 7 publications

The risk of non-union per fracture: current myths and revised figures from a population of over 4 million adults

The risk of non-union per fracture: current myths and revised figures from a population of over 4 million adults

The effect of osteoporosis and its treatment on fracture healing a systematic review of animal and clinical studies

Analysis of Risk Factors for Non-Union After Surgery for Limb Fractures: A Case-Control Study of 669 Subjects

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