Systemic Bone Loss After Fracture

Abstract

A history of prior fracture is the most reliable indicator of prospective fracture risk. Increased fracture risk is not confined to the region of the prior fracture, but is operant at all skeletal sites, providing strong evidence of systemic bone loss after fracture. Animal and human studies suggest that systemic bone loss begins shortly after fracture and persists for several years in humans. In fact, bone quantity and bone quality may never fully return to their pre-fracture levels, especially in older subjects, demonstrating a need for improved understanding of the mechanisms leading to systemic bone loss after fracture in order to reduce subsequent fracture risk. Although the process remains incompletely understood, mechanical unloading (disuse), systemic inflammation, and hormones that control calcium homeostasis may all contribute to systemic bone loss. Additionally, individual factors can potentially affect the magnitude and time course of systemic bone loss and recovery. The magnitude of systemic bone loss correlates positively with injury severity and age. Men may also experience greater bone loss or less recovery than women after fracture. This review details the current understanding of systemic bone loss following fracture, including possible underlying mechanisms and individual factors that may affect this injury response.

Productivity loss associated with functional disability in a contemporary small-scale subsistence population

“…The manifestation of pain and functional disability following fracture appears to be quite variable both across individuals and within individuals over time (e.g. (Begerow et al 1999;Nevitt et al 1998;O'Neill et al 2004;Suzuki et al 2008) (Osipov et al 2018). Future research is needed to test the empirical adequacy of the hypothesized, sometimes bidirectional relationships shown in Figure 6.…”

Productivity loss associated with physical impairment in a contemporary small-scale subsistence population

“…acute infection, laceration, animal bite) as constraints on productivity (Bailey 1991;Sugiyama and Chacon 2000;Sugiyama 2004). Adult skeletal fractures can entail longerterm productivity constraints as they provoke systemic bone losses, incomplete recovery of bone quality (especially for older adults), increased risk of future fractures and longer-term disability (Osipov et al 2018). As most activities of daily living generate loads on human vertebrae (Myers and Wilson 1997;Rohlmann et al 2001;Stewart and Hall 2006), and since for many activities the greatest compressive loads along the spine are in the thoracolumbar region (Bruno et al 2017), thoracic vertebral body fracture can be rather debilitating for an obligate biped even after behavioral modifications that minimize its burden.…”

<p>Bone-mineral density: clinical significance, methods of quantification and forensic applications</p>

“…65 Another complication associated with fragility and bone fracture might be systemic bone loss after fracture, as witnessed in experimental and clinical studies. 66 In limb fractures, BMD within the injured limb decreases after fracture from 3% to 31% compared to baseline values measured close to the time of fracture. [67][68][69][70] This is a result of reduced formation of bone following fractures while resorption levels either remain unchanged or increase.…”

“…71 In part, the bone recovers with time, but bone mass may never return to the initial levels. 66 Fractures trigger bone loss not only locally, within the damaged region, but also systemically, affecting other skeletal sites. 66,72…”

“…66 Fractures trigger bone loss not only locally, within the damaged region, but also systemically, affecting other skeletal sites. 66,72…”