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Systemic Bone Loss After Fracture

  • Fracture
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Clinical Reviews in Bone and Mineral Metabolism Aims and scope Submit manuscript

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.

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Funding

The authors are supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), under award number R01 AR071459.

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  1. Lawrence J. Ellison Musculoskeletal Research Center, Department of Orthopaedic Surgery, University of California Davis Medical Center, 4635 2nd Avenue, Suite 2000, Sacramento, CA, 95817, USA

    Benjamin Osipov, Armaun J. Emami & Blaine A. Christiansen

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Correspondence to Benjamin Osipov.

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Osipov, B., Emami, A.J. & Christiansen, B.A. Systemic Bone Loss After Fracture. Clinic Rev Bone Miner Metab 16, 116–130 (2018). https://doi.org/10.1007/s12018-018-9253-0

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