Mechanisms Underlying Normal Fracture Healing and Risk Factors for Delayed Healing

  • Cheng Cheng
  • Dolores ShobackEmail author
Epidemiology and Pathophysiology (F Cosman and D Shoback, Section Editors)
Part of the following topical collections:
  1. Topical Collection on Epidemiology and Pathophysiology
  2. Topical Collection on Epidemiology and Pathophysiology


Purpose of Review

Substantial advances have been made in understanding the biological basis of fracture healing. Yet, it is unclear whether the presence of osteoporosis or prior or current osteoporosis therapy influences the healing process or is associated with impaired healing. This review discusses the normal process of fracture healing and the role of osteoporosis and patient-specific factors in relation to fracture repair.

Recent Findings

The definitive association of osteoporosis to impaired fracture healing remains inconclusive because of limited evidence addressing this point. eStudies testing anabolic agents in preclinical models of ovariectomized animals with induced fractures have produced mostly positive findings showing enhanced fracture repair. Prospective human clinical trials, although few in number and limited in design and to testing only one anabolic agent, have similarly yielded modestly favorable results.


Interest is high for exploring currently available osteoporosis therapies for efficacy in fracture repair. Definitive data supporting their efficacy are essential in achieving approval for this indication.


Fracture healing Risk factors Osteoporosis Bisphosphonates Denosumab Estrogen Raloxifene Parathyroid hormone (PTH) PTH-related peptide Atypical femoral fracture Sclerostin Dickkopf-1 


Compliance with Ethical Standards

Conflict of Interest

Dolores Shoback reports personal fees from Radius Pharamaceutical, outside the submitted work. Cheng Cheng declares that there is no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Endocrine Research Unit, Department of MedicineSan Francisco Veterans Affairs Medical CenterSan FranciscoUSA
  2. 2.Division of Endocrinology and Metabolism, Department of MedicineUniversity of CaliforniaSan FranciscoUSA

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