From the Guidelines
The fracture healing process is best supported by a combination of proper nutrition, adequate rest, appropriate medical care, and lifestyle modifications, with a focus on adequate calcium and vitamin D intake, as evidenced by the most recent and highest quality study 1. The key elements that support the fracture healing process include:
- A diet rich in calcium (1000-1200 mg daily) and vitamin D (800 IU daily), as recommended by the EULAR/EFORT guidelines 1, which provides essential building blocks for bone repair.
- Smoking cessation, as nicotine impairs blood flow to healing bones, and limitation of alcohol intake, as a non-healthy lifestyle may have negative effects on bone mineral density (BMD), bone quality, and the risk of falling 1.
- Adequate rest and immobilization through casts, splints, or surgical fixation to maintain bone alignment.
- Weight-bearing activities, when medically approved, to stimulate bone formation through mechanical stress.
- Adequate sleep (7-9 hours nightly) and stress management to support overall healing by optimizing hormone balance. The body's natural healing process involves three phases: inflammation, repair, and remodeling, which collectively restore the bone's structure and function. It is essential to note that while calcium and vitamin D supplementation is crucial, calcium alone has no demonstrated effect on fracture reduction and may be associated with gastrointestinal side effects and uncertainty regarding cardiovascular events 1. Therefore, a comprehensive approach that incorporates these elements and considers the individual patient's needs and risk factors is necessary to support the fracture healing process, as emphasized by the EULAR/EFORT recommendations 1.
From the Research
Factors Supporting Fracture Healing
The fracture healing process is a complex physiological process that involves a well-orchestrated series of biological events 2. Several factors support this process, including:
- Growth factors, which play a crucial role in initiating the cascade of critical cellular events of fracture healing 3
- Stem cells, which have the potential to differentiate into various cell types, including osteoblasts, which are essential for bone formation 2
- Natural grafts, such as autografts, allografts, and xenografts, which can provide a scaffold for bone growth and regeneration 2
- Biologic- and synthetic-based tissue-engineered scaffolds, which can mimic the structure and function of natural bone tissue 2
- Immobilization, which can help to stabilize the fracture site and promote healing 4
- Electromagnetic stimulation, which has been shown to accelerate fracture healing by up to 20-30% 5
- Parathyroid hormone, which has been shown to promote bone formation and accelerate fracture healing 5
Phases of Fracture Healing
The fracture healing process can be divided into three phases:
- Inflammatory phase, which is characterized by the activation of immune cells and the production of inflammatory cytokines 4, 6, 3
- Reparative phase, which is characterized by the formation of new bone tissue and the repair of damaged tissue 4, 6, 3
- Remodeling phase, which is characterized by the reconstitution of the original bone structure and the restoration of bone function 4, 6, 3
Factors Influencing Fracture Healing
Several factors can influence the fracture healing process, including:
- Local factors, such as the degree of local trauma and bone loss, the type of bone affected, and the degree of immobilization 4, 6
- Systemic factors, such as age, hormones, and systemic inflammation 4, 6
- Biomechanical factors, such as fracture fixation stability and the blood supply to the healing site 6