How do age, sex, and comorbidities (presence of additional diseases or disorders) affect the results of Platelet-Rich Plasma (PRP) therapy?

From the Guidelines

Age, sex, and comorbidities significantly influence the effectiveness of Platelet-Rich Plasma (PRP) therapy, with younger patients and those with fewer comorbidities tend to experience better outcomes. Generally, younger patients (under 50) tend to experience better outcomes from PRP treatments compared to older individuals, as aging decreases both platelet concentration and growth factor content 1. Sex differences also play a role, with some studies suggesting that women may respond differently than men due to hormonal variations, particularly estrogen which can affect platelet function. Regarding comorbidities, conditions like diabetes, thyroid disorders, and autoimmune diseases can substantially reduce PRP efficacy by impairing platelet function or altering the healing environment. For instance, diabetic patients typically show diminished growth factor release from platelets, while those with autoimmune conditions may experience altered inflammatory responses that interfere with PRP's regenerative mechanisms.

Key Factors Influencing PRP Therapy

• Age: Older patients tend to have lower platelet concentration and growth factor content, which can reduce the effectiveness of PRP therapy 1.
• Sex: Hormonal variations, particularly estrogen, can affect platelet function and influence the response to PRP therapy.
• Comorbidities: Conditions like diabetes, thyroid disorders, and autoimmune diseases can impair platelet function or alter the healing environment, reducing PRP efficacy.

Adjusting PRP Protocols

For optimal results, clinicians should consider adjusting PRP protocols based on these patient factors, potentially increasing concentration or treatment frequency for older patients or those with significant comorbidities. Patients taking anticoagulants or anti-inflammatory medications should temporarily discontinue these medications (with physician approval) before PRP treatment, as they can interfere with platelet activation. These variations occur because PRP therapy relies on the patient's own biological healing capacity, which is directly influenced by their overall health status and physiological condition. The most recent study on the topic, published in 2021, highlights the importance of considering age and comorbidities in the management of patients, which can be applied to PRP therapy 1.

From the Research

Correlation of PRP Results with Age, Sex, and Comorbidities

• The correlation of PRP results with age, sex, and comorbidities is a complex topic that has been studied in various research papers 2, 3, 4, 5, 6.
• Age: Studies have shown that younger patients tend to have better outcomes with PRP treatment. For example, a study on the treatment of anterior knee pain due to chondromalacia patellae with platelet-rich plasma and hyaluronic acid found that younger patients had more benefit from the treatment 6.
• Sex: While some studies have reported a higher incidence of certain conditions in women, such as anterior knee pain due to chondromalacia patellae 6, there is limited evidence to suggest that sex has a significant impact on PRP results.
• Comorbidities: The presence of comorbidities, such as diabetes, can affect the outcomes of PRP treatment. For example, a study on the treatment of diabetic foot ulcers with PRP found that the wound healing rate was higher in the PRP treatment group compared to the control group 4.

Effect of PRP on Different Conditions

• Diabetic Foot Ulcers: PRP has been shown to be effective in treating diabetic foot ulcers, with studies reporting improved wound healing rates and reduced healing time 2, 4.
• Gluteus Medius and Minimus Tendinopathy: A study on the treatment of gluteus medius and minimus tendinopathy with leucocyte-rich PRP found that the PRP group had greater improvement in pain and function compared to the corticosteroid injection group 5.
• Anterior Knee Pain: PRP has been shown to be effective in treating anterior knee pain due to chondromalacia patellae, with studies reporting improved patient-related measures such as VAS and Kujala scores 6.

Mechanism of Action of PRP

• Growth Factors: PRP contains growth factors that promote tissue regeneration and healing 3.
• Autophagy: PRP has been shown to regulate autophagy, which may contribute to its therapeutic effects 4.
• Inflammatory Response: PRP has been shown to reduce inflammatory response, which may contribute to its therapeutic effects 4, 5.