Diabetes and Healing Outcomes in Lower Extremity Fractures: A Systematic Review

Gortler, Hilary; Rusyn, Jessyca; Godbout, Charles; Chahal, Jas; Schemitsch, Emil H.; Nauth, Aaron

doi:10.1016/j.injury.2017.11.006

Cited by 71 publications

(44 citation statements)

References 31 publications

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“…However, nowadays a dramatic worldwide demographic change towards an aging society along with a high increase of metabolic diseases, such as diabetes mellitus type 2, forces society to tackle the gaps in knowledge about bone disorders, such as osteoporosis. Several studies confirmed that a number of comorbidities, such as smoking, kidney diseases, diabetes or nonsteroidal anti-inflammatory drug (NSAID) abuse, increase the complication rate of fracture healing [1,2,3,4,5,6]. Moreover, we and others identified that malnutrition is another important risk factor clearly linked to delayed bone healing and delayed patient discharge from the hospital [7,8,9].…”

Section: Introductionsupporting

confidence: 63%

From the Clinical Problem to the Basic Research—Co-Culture Models of Osteoblasts and Osteoclasts

Zhu¹,

Ehnert²,

Rouß³

et al. 2018

IJMS

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Bone tissue undergoes constant remodeling and healing when fracture happens, in order to ensure its structural integrity. In order to better understand open biological and clinical questions linked to various bone diseases, bone cell co-culture technology is believed to shed some light into the dark. Osteoblasts/osteocytes and osteoclasts dominate the metabolism of bone by a multitude of connections. Therefore, it is widely accepted that a constant improvement of co-culture models with both cell types cultured on a 3D scaffold, is aimed to mimic an in vivo environment as closely as possible. Although in recent years a considerable knowledge of bone co-culture models has been accumulated, there are still many open questions. We here try to summarize the actual knowledge and address open questions.

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Section: Introductionsupporting

confidence: 63%

From the Clinical Problem to the Basic Research—Co-Culture Models of Osteoblasts and Osteoclasts

Zhu¹,

Ehnert²,

Rouß³

et al. 2018

IJMS

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show abstract

“…Bone health is affected by diabetes. Both type 1 diabetes (T1D) and type 2 diabetes (T2D) are associated with a higher risk of hip fractures, altered bone mineral density (BMD) and prolonged fracture healing time . In T1D, the BMD is significantly lower than in controls, whereas patients with T2D have a higher BMD compared to controls .…”

Section: Introductionmentioning

confidence: 99%

Bone turnover markers in children and adolescents with type 1 diabetes—A systematic review

et al. 2019

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Background and aim In rodents, osteocalcin (OCN) stimulates insulin production and insulin sensitivity, both important factors during partial remission in humans with type 1 diabetes (T1D). However, decreased OCN has been reported in both adult and pediatric T1D. This study aims at investigating bone turnover and partial remission in children and adolescents with recent onset T1D. Subjects and methods Ninety‐nine individuals (33% girls) were recruited within 3 months of T1D onset and examined three times, 6 months apart. Outcome variables were bone formation markers OCN and procollagen type 1 amino‐terminal propeptide (P1NP) and the bone resorption marker C‐terminal crosslinked telopeptide of type 1 collagen (CTX). Dependent variables included IDAA1c (surrogate marker of partial remission), total body bone mineral density (BMD) and stimulated C‐peptide as representative of endogenous insulin production. Results OCN‐ and P1NP Z‐scores were significantly decreased throughout the study, whereas CTX Z‐scores were increased. None of the bone turnover markers changed significantly between visits. Total body BMD Z‐score did not change during the study but was significantly higher than the reference population at visit 2 (P = .035). There were no differences in the bone turnover markers for those in partial remission as defined by either C‐peptide or IDAA1c at any visit. The individual change in CTX Z‐score was negatively associated with the increase of IDAA1c (P = .030) independent of C‐peptide decline (P = .034). Conclusion Bone turnover markers indicate increased bone resorption and decreased bone formation during the first year of T1D. The negative association between bone resorption and IDAA1c might represent compensatory mechanisms affecting insulin sensitivity.

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“…There was a positive correlation between patients requiring re‐hospitalization and the coexistence of either diabetes or respiratory diseases . According to Gortler et al, coexisting DM significantly impairs healing in lower extremity fractures. In a review, it has been reported that the rate of infections, re‐operations, malunions and nonunions is significantly higher in DM patients.…”

Section: Skeleton and Diabetesmentioning

confidence: 99%

“…According to the data, blood viscosity in DM patients is increased, leading to hypoxia of tissues. As a result, inflammatory reactions are slowed down, impairing wound healing and increasing infection risk . Pollock et al, in a retrospective study of 1486 patients, reported a risk of hospital re‐admission for patients with fractures of the proximal end of the femur (femoral neck fractures, intertrochanteric and subtrochanteric fractures) within 30 days of discharge after primary surgery.…”

Section: Skeleton and Diabetesmentioning

confidence: 99%

Influence of diabetes on tissue healing in orthopaedic injuries

Stolarczyk

Sarzyńska

Gondek

et al. 2018

Clin Exp Pharma Physio

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Diabetes is a group of metabolic diseases characterized by hyperglycaemia resulting from the defective action or secretion of insulin. Chronic hyperglycaemia can lead to the damage, dysfunction and failure of various organs. In the context of complications of healing and orthopaedic rehabilitation, vascular (microangiopathy) and nerve (neuropathy) disorders deserve particular attention. About 12% of the patients admitted to orthopaedic departments have diabetes. Studies indicate that there is an indisputable link between diabetes and: an increased risk of fractures, the difficult healing of injuries of bones, ligaments and musculotendinous. It appears that one of the main reasons for this is non-enzymatic glycosylation (glycation) of collagen molecules, a phenomenon observed in the elderly and diabetic populations, as it leads to the formation of advanced glycation end products (AGEs). Collagen is one of the major connective tissue components, and is therefore part of ligaments, tendons and bones. AGEs affect the weakening of its structure and biomechanical properties, and thus also affects the weakening of the structure and properties of the above-mentioned tissues. The aim of the study is to undertake an overview of the current knowledge of the impact of diabetes on the risk of some injuries and subsequent healing and rehabilitation of patients following orthopaedic injuries.

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Diabetes and Healing Outcomes in Lower Extremity Fractures: A Systematic Review

Cited by 71 publications

References 31 publications

From the Clinical Problem to the Basic Research—Co-Culture Models of Osteoblasts and Osteoclasts

From the Clinical Problem to the Basic Research—Co-Culture Models of Osteoblasts and Osteoclasts

Bone turnover markers in children and adolescents with type 1 diabetes—A systematic review

Influence of diabetes on tissue healing in orthopaedic injuries

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