Féron Jean-Marc, Mauprivez Raphaël
Professor of Orthopaedic Surgery, Chair of the Orthopaedic and Trauma Department, Saint Antoine Hospital. UPMC-Sorbonne Universities, Paris, France.
Senior lecturer, Orthopaedic and Trauma Department, Saint Antoine Hospital. UPMC-Sorbonne Universities, Paris, France.
Injury. 2016 Jan;47 Suppl 1:S10-4. doi: 10.1016/S0020-1383(16)30003-1.
Bone differs from other tissues in its capacity to self-repair after a fracture. The low bone mass and structural deterioration of bone associated with osteoporosis increases the risk of fragility fracture compared with healthy individuals. The intention of this article is to review the complex process of fracture repair and essential requirements for a successful fracture healing response summarized as the "diamond concept" in terms of aging and osteoporosis. The current preclinical and clinical evidence for a beneficial or harmful influence of anti-osteoporosis medications such as bisphosphonates, parathyroid hormone (PTH), strontium ranelate and antibodies of Wnt-inhibiting signaling proteins on bone healing is presented and discussed. Literature suggests that there are no detrimental consequences of such therapeutics on fracture repair processes. Following a fragility fracture, it seems that early start of preventive anti-osteoporotic treatment right after surgery does not delay the union of the fracture, except perhaps in the case of very rigidly fixed fracture requiring direct bone healing. There is some promising experimental and clinical evidence for possible enhancement of the bone repair process via administration of systemic agents. Further well designed studies in humans are necessary to accumulate more evidence on the positive effects and to translate this knowledge into valid therapeutic applications.
骨骼与其他组织的不同之处在于其在骨折后具有自我修复的能力。与健康个体相比，骨质疏松症相关的低骨量和骨结构恶化会增加脆性骨折的风险。本文旨在综述骨折修复的复杂过程以及成功的骨折愈合反应的基本要求，这些要求在衰老和骨质疏松症方面被总结为“钻石概念”。文中展示并讨论了当前关于双膦酸盐、甲状旁腺激素（PTH）、雷奈酸锶和Wnt抑制信号蛋白抗体等抗骨质疏松药物对骨愈合有益或有害影响的临床前和临床证据。文献表明，此类治疗方法对骨折修复过程没有不利影响。发生脆性骨折后，似乎术后尽早开始预防性抗骨质疏松治疗不会延迟骨折愈合，除非是需要直接骨愈合的非常牢固固定的骨折。有一些关于通过全身给药可能增强骨修复过程的有前景的实验和临床证据。还需要在人体中进行进一步精心设计的研究，以积累更多关于积极效果的证据，并将这些知识转化为有效的治疗应用。
