Growth hormone: does it have a therapeutic role in fracture healing?

Tran, Gui; Pagkalos, Joseph; Tsiridis, Evgenios; Narvani, Amir Ali; Heliotis, Manolis; Mantalaris, Athanasios; Tsiridis, Eleftherios

doi:10.1517/13543780902893069

Cited by 23 publications

(13 citation statements)

References 160 publications

(256 reference statements)

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“…As an alternative to local augmentation of the bone-regeneration process, the use of systemic agents, including growth hormone (GH) [80] and parathyroid hormone (PTH) [81] is also under extensive research. Current evidence suggests a positive role for GH in fracture healing, but there are issues about its safety profile and optimal dose, when systemically administered to enhance bone repair [80].…”

Section: Systemic Enhancement Of Bone Regenerationmentioning

confidence: 99%

“…Current evidence suggests a positive role for GH in fracture healing, but there are issues about its safety profile and optimal dose, when systemically administered to enhance bone repair [80]. There are also numerous animal studies and clinical trials showing that intermittent PTH administration induces both cancellous and cortical bone regeneration, enhances bone mass, and increases mechanical bone strength and bone-mineral density, with a relatively satisfactory safety profile [81,82].…”

Section: Systemic Enhancement Of Bone Regenerationmentioning

confidence: 99%

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Bone regeneration: current concepts and future directions

Dimitriou

Jones

McGonagle

et al. 2011

BMC Med

1,553

1,108

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Bone regeneration is a complex, well-orchestrated physiological process of bone formation, which can be seen during normal fracture healing, and is involved in continuous remodelling throughout adult life. However, there are complex clinical conditions in which bone regeneration is required in large quantity, such as for skeletal reconstruction of large bone defects created by trauma, infection, tumour resection and skeletal abnormalities, or cases in which the regenerative process is compromised, including avascular necrosis, atrophic non-unions and osteoporosis. Currently, there is a plethora of different strategies to augment the impaired or 'insufficient' bone-regeneration process, including the 'gold standard' autologous bone graft, free fibula vascularised graft, allograft implantation, and use of growth factors, osteoconductive scaffolds, osteoprogenitor cells and distraction osteogenesis. Improved 'local' strategies in terms of tissue engineering and gene therapy, or even 'systemic' enhancement of bone repair, are under intense investigation, in an effort to overcome the limitations of the current methods, to produce bone-graft substitutes with biomechanical properties that are as identical to normal bone as possible, to accelerate the overall regeneration process, or even to address systemic conditions, such as skeletal disorders and osteoporosis.

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Section: Systemic Enhancement Of Bone Regenerationmentioning

confidence: 99%

Section: Systemic Enhancement Of Bone Regenerationmentioning

confidence: 99%

Bone regeneration: current concepts and future directions

Dimitriou

Jones

McGonagle

et al. 2011

BMC Med

1,553

1,108

View full text Add to dashboard Cite

show abstract

“…Other growth factors that are currently under investigation include growth and differentiation factor-5 (GDF-5) [ 34 ], insulin-like growth factor-1 (IGF-1) [ 35 , 36 ], growth hormone (GH) [ 37 ] and platelet-rich plasma (PRP) [ 38 -40 ].…”

Section: Growth Factorsmentioning

confidence: 99%

Bone Healing: The Diamond Concept

Giannoudis

Panteli

2014

European Instructional Lectures

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The incidence of fracture non-union has been estimated to be as high as 10 %. The treatment of fracture non-union remains challenging even for the most experienced surgeons. The presence of a poor soft tissue envelope, deformity, avascular bone edges, reduced bone stock, low-grade infection and patient related co-morbidities are some of the important contributing factors that need to be addressed. Evaluation of the complexity of the non-union and formulating the appropriate pre-operative plan and treatment modality requires good understanding of the pathogenicity of this condition and having extensive surgical experience.The state of both the mechanical and biological environment, is thought to play a crucial role in the decision making process regarding revision surgery. Application of the so-called 'diamond concept' provides the optimum mechano-biological conditions for bone repair and should be considered in cases where diffi culties to achieve union are anticipated. Types of Bone HealingWith regards to the histology of bone healing two basic types have been described, depending on the stability of fi xation of the fracture's bone fragments [ 2 , 3 , 6 ]. 1. The primary (direct) healing pattern occurs when there is absolute contact of the bone fragments (anatomical reduction) along with almost complete stability (commonly obtained with open reduction and internal fi xation) and therefore minimisation of the inter-fragmentary strains [ 7 , 8 ]. In this type of healing that rarely happens in nature, the disrupted continuity of the bone is re-established with regeneration of lamellar bone and the Harvesian system, and has no need of any remodelling [ 8 , 9 ]. 2. The secondary (indirect) healing pattern occurs in the vast majority of clinical cases and depends on the formation of fi brocartilaginous callus that matures to mineralised cartilage and fi nally bone [ 2 , 7 ]. Callus is formed as a physiological reaction to the inter-fragmentary movement and involves both intramembranous and endochondral ossifi cation [ 2 , 7 -9 ]. It originates from committed osteoprogenitor cells of the periosteum and undifferentiated multipotent mesenchymal stem cells (MSCs) [ 7 ]. Fracture Healing and Bone RepairSeveral types of tissues are involved in the process of fracture healing including cortical bone, periosteum, undifferentiated fascial tissue that surrounds the fracture, and bone marrow [ 9 , 10 ]. Bone repair follows a well defi ned chain of events starting with haematoma formation, followed by infl ammation, angiogenesis and granulation tissue formation, fi brous tissue formation, fi brocartilage, hyaline cartilage (soft callus), cartilage mineralisation, woven bone (hard callus), and fi nally remodelling [ 2 , 6 , 11 ]. The process of remodelling can last for several months.In more detail, following an injury the bone architecture and the surrounding soft tissue continuity are both disrupted. The concomitant tearing of the blood vessels at the site of injury leads to bleeding, activation of the coagulation casc...

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“…Growth hormone appears to have a positive influence on fracture healing in animals and humans. [163] Parathyroid hormone (PTH) has been shown to have a positive effect on fracture healing, especially for osteoporotic bones. [164,165] The latest large animal investigations have reported improved bone defect healing by local delivery of PTH.…”

Section: Hormone and Gene Therapymentioning

confidence: 99%

Recommendations and Considerations for the Use of Biologics in Orthopedic Surgery

et al. 2012

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Reconstruction of extensive bone defects remains technically challenging and has considerable medical and financial impact on our society. Surgical procedures often require a bone/substitute graft to enhance and accelerate bone repair. Bone autografts are associated with morbidity related to bone harvesting and are limited in quantity. Alternatively, bone allografts expose the patient to the risk of transmission of infectious disease. Synthetic bone graft substitutes, such as calcium sulfates, hydroxyapatite, tricalcium phosphate, and combinations, circumvent some of the disadvantages of auto- and allografts, but have limited indications. Biomedical research has made possible the stimulation of the body’s own healing mechanisms, either by delivering exogenous growth factors locally, or by stimulating their local production by gene transfer. Among all known factors having osteoinductive properties, only two bone morphogenetic proteins (for specific indications) and demineralized bone matrix have been approved for clinical use. In addition, ongoing research is exploring the efficacy of cell therapy and tissue engineering. The present report examines the composition, biological properties, indications, clinical experience and regulations of several of the biotherapeutics employed for bone reconstruction.

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Growth hormone: does it have a therapeutic role in fracture healing?

Abstract: The optimal dose and method of administration is still to be determined, and the safety profile of this novel use of GH needs to be investigated prior to establishing its widespread use as a fracture-healing agent.

Cited by 23 publications

References 160 publications

Bone regeneration: current concepts and future directions

Bone regeneration: current concepts and future directions

Bone Healing: The Diamond Concept

Recommendations and Considerations for the Use of Biologics in Orthopedic Surgery

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