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Impaired healing of fragility fractures in type 2 diabetes: clinical and radiographic assessments and serum cytokine levels

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Abstract

Background

Diabetes induces bone alterations accompanied by altered cytokine expression patterns. These alterations lead to modified fracture healing, contributing to musculoskeletal fragility in the elderly.

Aims

We evaluated the inflammatory immune response in diabetic patients during fracture healing relative to clinical and radiographic assessments.

Methods

Fifty patients of both sexes with fragility fractures were studied: 30 diabetics (group A, mean age 73.4 ± 11.2 years) and 20 normoglycemic controls (group B, mean age 75.1 ± 16.9 years). Two subgroups comprised those with hip or wrist fragility fractures (25 and 16 patients, respectively). We evaluated serum concentrations of tumor necrosis factor α, interleukins 4 and 8, monocyte chemotactic protein-1 (MCP-1), vascular endothelial growth factor, and epidermal growth factor (EGF) before and at 4 and 8 weeks after surgery. We also determined the Radiographic Union Score for Hips and the Radius Union Scoring System score and applied the Physical Activity Scale for the Elderly test at the same time points. Each patient underwent bone densitometry.

Results

MCP-1 and EGF levels were higher in group A than in group B at 4 weeks after surgery (p > 0.05). Radiographic evaluation showed lower scores in group A (p < 0.05). The main difference between the groups was evident 4 weeks after surgery. Changes in the serum concentrations of chemotactic and angiogenic factors could explain the radiographically proved impaired fracture healing in diabetic patients.

Conclusions

Fragility fracture healing is impaired in diabetic patients. Radiographic and molecular patterns confirmed that the most compromised fracture-healing phase is at 4 weeks after surgery, during callus mineralization.

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Authors and Affiliations

  1. Graduate School of Orthopaedics and Traumatology, University of Rome Tor Vergata, Policlinico Tor Vergata Foundation, 81 Viale Oxford, 00133, Rome, Italy

    Federico Maria Liuni, Maurizio Feola & Cecilia Rao

  2. Department of Orthopaedics and Traumatology, University of Rome Tor Vergata, Policlinico Tor Vergata Foundation, Rome, Italy

    Clelia Rugiero, Pietro Pistillo & Umberto Tarantino

  3. Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy

    Chiara Terracciano

  4. Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, Rome, Italy

    Maria Gabriella Giganti

Authors
  1. Federico Maria Liuni
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  2. Clelia Rugiero
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  3. Maurizio Feola
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  4. Cecilia Rao
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  5. Pietro Pistillo
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  6. Chiara Terracciano
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  7. Maria Gabriella Giganti
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  8. Umberto Tarantino
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Correspondence to Federico Maria Liuni.

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On behalf of all authors, the corresponding author states that there is no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Liuni, F.M., Rugiero, C., Feola, M. et al. Impaired healing of fragility fractures in type 2 diabetes: clinical and radiographic assessments and serum cytokine levels. Aging Clin Exp Res 27 (Suppl 1), 37–44 (2015). https://doi.org/10.1007/s40520-015-0422-4

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  • DOI: https://doi.org/10.1007/s40520-015-0422-4

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