Department of Veterans Affairs: Tennessee Valley Healthcare System (VISN 9), Nashville, USA,
Curr Osteoporos Rep. 2014 Mar;12(1):48-54. doi: 10.1007/s11914-014-0187-2.
Healing fractures resulting from osteoporosis or cancer remains a significant clinical challenge. In these populations, healing is often impaired not only due to age and disease, but also by other therapeutic interventions such as radiation, steroids, and chemotherapy. Despite substantial improvements in the treatment of osteoporosis over the last few decades, osteoporotic fractures are still a major clinical challenge in the elderly population due to impaired healing. Similar fractures with impaired healing are also prevalent in cancer patients, especially those with tumor growing in bone. Treatment options for cancer patients are further complicated by the fact that bone anabolic therapies are contraindicated in patients with tumors. Therefore, many patients undergo surgery to repair the fracture, and bone grafts are often used to stabilize orthopedic implants and provide a scaffold for ingrowth of new bone. Both synthetic and naturally occurring biomaterials have been investigated as bone grafts for repair of osteoporotic fractures, including calcium phosphate bone cements, resorbable polymers, and allograft or autograft bone. In order to re-establish normal bone repair, bone grafts have been augmented with anabolic agents, such as mesenchymal stem cells or recombinant human bone morphogenetic protein-2. These developing approaches to bone grafting are anticipated to improve the clinical management of osteoporotic and cancer-induced fractures.
治疗骨质疏松症或癌症引起的骨折仍然是一个重大的临床挑战。在这些人群中，骨折的愈合常常受到多种因素的影响，不仅是由于年龄和疾病，还包括其他治疗干预措施，如放疗、类固醇和化疗。尽管过去几十年中骨质疏松症的治疗取得了实质性进展，但由于愈合受损，老年人群中的骨质疏松性骨折仍然是一个主要的临床挑战。在癌症患者中，类似的愈合受损的骨折也很常见，尤其是那些肿瘤在骨内生长的患者。由于骨合成代谢治疗在肿瘤患者中被禁用，癌症患者的治疗选择更加复杂。因此，许多患者接受手术来修复骨折，并且经常使用骨移植物来稳定矫形植入物并为新骨的长入提供支架。合成和天然存在的生物材料都被研究用作修复骨质疏松性骨折的骨移植物，包括磷酸钙骨水泥、可吸收聚合物以及同种异体或自体骨。为了重新建立正常的骨修复，骨移植物已经用合成代谢剂进行了增强，例如间充质干细胞或重组人骨形态发生蛋白-2。这些正在发展的骨移植方法有望改善骨质疏松症和癌症引起的骨折的临床管理。
