Bone turnover markers (BTMs) are released during bone remodeling and are thought to reflect the metabolic activity of bone at the cellular level. This review examines BTM as a biological response marker for monitoring future fracture prediction and fracture healing processes. Substantial evidence has been of high value to investigate the use of BTM in fracture risk prediction; nevertheless, the conclusions of some studies are inconsistent due to their large variability. BTM is promising for fracture risk prediction for adopting international reference standards or providing absolute risks, such as 10-year fracture probabilities. There are uncertainties over their clinical use for monitoring osteoporotic fracture healing. More rigorous evidence is needed that can provide more detailed insights for fracture healing and for ascertaining the progression of fracture healing.

/pdf/clinical-utility-of-biochemical-marker-of-bone-turnover-3cldxp0tv0.pdf

Clinical Utility of Biochemical Marker of Bone Turnover: Fracture Risk Prediction and Bone Healing

The incidence of osteoporotic fractures increases as our population ages. Until now, the exact biochemical processes that occur during the healing of metaphyseal fractures remain unclear. Diagnostic instruments that allow a dynamic insight into the fracture healing process are as yet unavailable. In the present matched pair analysis, we study the time course of the osteoanabolic markers bone specific alkaline phosphatase (BAP) and transforming growth factor β1 (TGFβ1), as well as the osteocatabolic markers crosslinked C-telopeptide of type-I-collagen (β-CTX) and serum band 5 tartrate-resistant acid phosphatase (TRAP5b), during the healing of fractures that have a low level of bone mineral density (BMD) compared with fractures that have a normal BMD. Between March 2007 and February 2009, 30 patients aged older than 50 years who suffered a metaphyseal fracture were included in our study. BMDs were verified by dual energy Xray absorptiometry (DXEA) scans. The levels of BTMs were examined over an 8-week period. Osteoanabolic BAP levels in those with low levels of BMD were significantly different from the BAP levels in those with normal BMD. BAP levels in the former group increased constantly, whereas the latter group showed an initial strong decrease in BAP followed by slowly rising values. Osteocatabolic β-CTX increased in the bone of the normal BMD group constantly, whereas these levels decreased significantly in the bone of the group with low BMD from the first week. TRAP5b was significantly reduced in the low level BMD group. With this work, we conduct first insights into the molecular biology of the fracture healing process in patients with low levels of BMD that explains the mechanism of its fracture healing. The results may be one reason for the reduced healing qualities in bones with low BMD.

/pdf/characteristics-of-bone-turnover-in-the-long-bone-metaphysis-4teprlp0u3.pdf

Characteristics of bone turnover in the long bone metaphysis fractured patients with normal or low Bone Mineral Density (BMD).

[This corrects the article DOI: 10.1371/journal.pone.0096058.].

Correction: Characteristics of bone turnover in the long bone metaphysis fractured patients with normal or low Bone Mineral Density (BMD)

Fracture healing in osteoporotic bone is often considered different from that in younger bone. In fact, bone healing is a delicately choreographed dance between cells, various pathways and factors, local mechanical environment and vascularity. Ageing, osteoporosis, and drugs used to treat osteoporosis are among risk factors that impact fracture healing. An understanding of physiology, biomechanics, and effects of anti-osteoporotic drugs would be helpful to the orthopaedic surgeon in optimising osteoporotic fracture fixation outcomes and minimising complications. 

Fracture Healing in Osteoporotic Bone

Backgrounds: Bones healing is a complex multi steps process, Moringa Oliefera”s flavonoids and Marine collagen enhance minerals density of bones.Objectives: Differences in healing process in bones where evaluated in this study among bone defects that heal normally ( control group) and (experimental groups) using Marine collagen (MC), Moringa oleifera extract (MO) and combination of (MO &MC). Material and Methods: in this study twenty albino rats, after anesthesia bone defects were created in both femurs by drilling. In ten rats, the right bone defects left to heal normally, and left MO added to the bone defects, in other ten rats MC added to the right bone defects, left defects treated with MO & MC. Rats were scarified after 2 and 4 weeks. Immunohistochemical analysis of bone marrow stromal cells, osteocytes, osteoblasts and osteoclasts done using Procollagen type I N-terminal Propeptide (PINP). Results: Immunohistochemical result revealed stronger positive expression of PINP in bone defects treated with (MO&MC) than that other groups Conclusions: Treatment of bone defects with MO and MC showed increase osteogenic capacity by increase the immunoreactivity of PINP.

https://tjds.tu.edu.iq/index.php/tjds/article/download/116/53

Localization Of Procollagen Type I N-Terminal Propeptide in Bone Healing Treated by Local Application of Moringa Oliefera /Marine Collagen in Rats

The activity and metabolism of fracture healing can be monitored quantitatively by measuring bone turnover markers (BTMs) in serum or urine. However, in osteoporotic bone, the exact metabolism processes during the healing of metaphyseal fractures remain unknown. There is no diagnostic approach which currently allows dynamic insight into the fracture healing processes in order to monitor the progression of healing and to assist in therapeutic decision making. Between March 2007 and February 2009, 30 patients over 50 years of age who suffered a metaphyseal fracture were included in our study. The levels of the osteoanabolic marker BAP (bone-specific alkaline phosphatase) and osteocatabolic marker β-CTX [crosslinked C-(CTX)-telopeptide-of-type-I-collagen] were monitored during the fracture healing of osteoporotic and nonosteoporotic fractures for a duration of 8 weeks. After an initial decrease of BAP in the first week, the BAP level steadily increased through the fourth week in both groups. The levels of BAP in the osteoporotic group surpassed the healthy group. β-CTX steadily increased in healthy bone up to the fourth week; in osteoporotic bone, β-CTX first increased and, thereafter, decreased from the first week onwards. In this work, the first molecular biological aspects of osteoporotic fracture healing have been uncovered, helping to explain the mechanisms of delayed fracture healing in osteoporotic bone. The early decrease of reduced β-CTX as well as elevated BAP during the healing process may be the first aspects within the delayed healing of osteoporotic bone. Further studies are necessary in order to achieve more detailed insight to fracture healing and to ascertain the progression of fracture healing as being essential (criteria) for therapeutic decision making.

Characteristics of bone metabolism markers during the healing of osteoporotic versus nonosteoporotic metaphyseal long bone fractures: a matched pair analysis

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Characteristics of bone metabolism markers during the healing of osteoporotic versus nonosteoporotic metaphyseal long bone fractures: a matched pair analysis