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Current Osteoporosis Reports
Published in: Current Osteoporosis Reports 5/2022

12-08-2022 | Fracture Healing | Bone and Diabetes (A Schwartz and P Vestergaard, Section Editors)

Diabetes and Impaired Fracture Healing: A Narrative Review of Recent Literature

Authors: Mina Tanios, Bradley Brickman, Emily Cage, Kassem Abbas, Cody Smith, Marina Atallah, Sudipta Baroi, Beata Lecka-Czernik

Published in: Current Osteoporosis Reports | Issue 5/2022

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Abstract

Purpose of the Review

Diabetes mellitus is a chronic metabolic disorder commonly encountered in orthopedic patients. Both type 1 and type 2 diabetes mellitus increase fracture risk and impair fracture healing. This review examines complex etiology of impaired fracture healing in diabetes.

Recent Findings

Recent findings point to several mechanisms leading to orthopedic complications in diabetes. Hyperglycemia and chronic inflammation lead to increased formation of advanced glycation end products and generation of reactive oxygen species, which in turn contribute to the disruption in osteoblast and osteoclast balance leading to decreased bone formation and heightening the risk of nonunion or delayed union as well as impaired fracture healing. The mechanisms attributing to this imbalance is secondary to an increase in pro-inflammatory mediators leading to premature resorption of callus cartilage and impaired bone formation due to compromised osteoblast differentiation and their apoptosis. Other mechanisms include disruption in the bone’s microenvironment supporting different stages of healing process including hematoma and callus formation, and their resolution during bone remodeling phase. Complications of diabetes including peripheral neuropathy and peripheral vascular disease also contribute to the impairment of fracture healing. Certain diabetic drugs may have adverse effects on fracture healing.

Summary

The pathophysiology of impaired fracture healing in diabetic patients is complex. This review provides an update of the most recent findings on how key mediators of bone healing are affected in diabetes.
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Metadata
Title
Diabetes and Impaired Fracture Healing: A Narrative Review of Recent Literature
Authors
Mina Tanios
Bradley Brickman
Emily Cage
Kassem Abbas
Cody Smith
Marina Atallah
Sudipta Baroi
Beata Lecka-Czernik
Publication date
12-08-2022
Publisher
Springer US
Published in
Current Osteoporosis Reports / Issue 5/2022
Print ISSN: 1544-1873
Electronic ISSN: 1544-2241
DOI
https://doi.org/10.1007/s11914-022-00740-z

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