Acta Chir Orthop Traumatol Cech. 2015; 82(4):268-273 | DOI: 10.55095/achot2015/041
Delayed Fracture Healing in Diabetics with Distal Radius FracturesOriginal papers
- 1 Abteilung für Innere Medizin-Diabetologie, Klinikum Traunstein, Traunstein, Germany
- 2 Klinik und Poliklinik für Unfallchirurgie, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
- 3 Berufsgenossenschaftliche Unfallklinik Tübingen, Eberhard Karls Universität Tübingen, Tübingen, Germany
PURPOSE OF THE STUDY:
Diabetics may have an increased fracture risk, depending on disease duration, quality of metabolic adjustment and extent of comorbidities, and on an increased tendency to fall. The aim of this retrospective one-centre study consisted in detecting differences in fracture healing between patients with and without diabetes mellitus. Data of patients with the most common fracture among older patients were analyzed.
MATERIAL AND METHODS:
Classification of distal radius fractures was established according to the AO classification. Inital assessment and follow-up were made by conventional X-rays with radiological default settings. To evaluate fracture healing, formation of callus and sclerotic border, assessment of the fracture gap, and evidence of consolidation signs were used.
RESULTS:
The authors demonstrated that fracture morphology does not influence fracture healing regarding time span, neither concerning consolidation signs nor in fracture gap behaviour. However, tendency for bone remodeling is around 70% lower in investigated diabetics than in non-diabetics, while probability for a successful fracture consolidation is 60% lower.
CONCLUSIONS:
To corroborate the authors hypothesis of delayed fracture healing in patients with diabetes mellitus, prospective studies incorporating influencing factors like duration of metabolic disease, quality of diabetes control, medical diabetes treatment, comorbidities and secondary diseases, like chronic nephropathy and osteoporosis, have to be carried out.
Keywords: diabetes, delayed fracture healing, distal radius fractures, callus formation, blood glucose level, osteoblasts
Published: August 1, 2015 Show citation
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References
- IDF Diabetes Atlas, 6th edition. IDF., 2013.
- BLAKYTNY, R., SPRAUL, M., JUDE, E. B.: Review: The diabetic bone: a cellular and molecular perspective. Int. J. Low. Extrem. Wounds, 10: 16-32, 2011.
Go to original source...
Go to PubMed...
- BROWNLEE, M., CERAMI, A., VLASSARA, H.: Advanced glycosylation end products in tissue and the biochemical basis of diabetic complications. N. Engl. J. Med., 318: 1315-1321, 1988.
Go to original source...
Go to PubMed...
- CERAMI, A., VLASSARA, H., BROWNLEE, M.: Role of advanced glycosylation products in complications of diabetes, Diabetes Care, 11 (Suppl. 1): 73-79, 1988.
- FLODIN, L. SÄÄF, M., CEDERHOLM, T., AL-ANI, A. N., ACKERMANN, P. W., SAMNEGÅRD, E., DALEN, N., HEDSTRÖM, M.: Additive effects of nutritional supplementation, together with bisphosphonates, on bone mineral density after hip fracture: a 12-month randomized controlled study. Clin. Interv. Aging, 9: 1043-1050, 2014.
Go to original source...
Go to PubMed...
- FREUDE, T., BRAUN, K. F., HAUG, A., PSCHERER, S., STÖCKLE, U., NÜSSLER, A. K., EHNERT, S.: Hyperinsulinemia reduces osteoblast activity in vitro via upregulation of TGF-beta. J. Mol. Med. (Berl), 90: 1257-1266, 2012.
Go to original source...
Go to PubMed...
- HEATH 3rd, H., MELTON 3rd, L. J., CHU, C. P.: Diabetes mellitus and risk of skeletal fracture. N. Engl. J. Med., 303: 567-570, 1980.
Go to original source...
Go to PubMed...
- HOPPS, E., CAIMI, G.: Exercise in obesity management. J. Sports Med. Phys. Fitness, 51: 275-282, 2011.
- HWANG, Y. C., JEONG, I. K., AHN, K. J., CHUNG, H. Y.: Circulating osteocalcin level is associated with improved glucose tolerance, insulin secretion and sensitivity independent of the plasma adiponectin level. Osteoporos. Int. 23: 1337-1342, 2012.
Go to original source...
Go to PubMed...
- KASAHARA, T., IMAI, S., KOJIMA, H., KATAGI, M., KIMURA, H., CHAN, L., MATSUSUE, Y.: Malfunction of bone marrow-derived osteoclasts and the delay of bone fracture healing in diabetic mice. Bone, 47: 617-625, 2010.
Go to original source...
Go to PubMed...
- KATAYAMA, Y., AKATSU, T., YANAMOTO, M., KUGAI, N., NAGATA, N.: Role of nonenzymatic glycosylation of type I collagen in diabetic osteopenia. J. Bone Miner. Res., 11: 931-937, 1996.
Go to original source...
Go to PubMed...
- KHAZAI, N. B., BECK JR., G. R., UMPIERREZ G. E.: Diabetes and fractures: an overshadowed association. Curr. Opin. Endocrinol. Diabetes Obes., 16: 435-445, 2009.
Go to original source...
Go to PubMed...
- KIDDER, L. S., CHEN, X., SCHMIDT, A. H., LEW, W. D.: Osteogenic protein-1 overcomes inhibition of fracture healing in the diabetic rat: a pilot study. Clin. Orthop. Relat. Res., 467: 3249-3256, 2009.
Go to original source...
Go to PubMed...
- KRAKAUER, J. C., McKENNA, M. J., BUDERER, N. F., RAO, D. S., WHITEHOUSE, F. W., PARFITT, A. M.: Bone loss and bone turnover in diabetes, Diabetes, 44: 775-782, 1995.
Go to original source...
- LA FONTAINE, J., SHIBUYA, N., SAMPSON, H. W., VALDERRAMA, P.: Trabecular quality and cellular characteristics of normal, diabetic, and Charcot bone. J. Foot Ankle Surg., 50: 648-653, 2011.
Go to original source...
Go to PubMed...
- LECKA-CZERNIK, B.: Bone loss in diabetes: use of antidiabetic thiazolidinediones and secondary osteoporosis. Curr. Osteoporos. Rep., 8: 178-184, 2010.
Go to original source...
Go to PubMed...
- LESLIE, W. D., LIX, L. M., PRIOR, H. J., DERKSEN, S., METGE, C., O'NEIL, J.: Biphasic fracture risk in diabetes: a population-based study. Bone, 40: 1595-1601, 2007.
Go to original source...
Go to PubMed...
- LESLIE, W. D., RUBIN, M. R., SCHWARTZ, A. V., KANIS, J. A.: Type 2 diabetes and bone. J. Bone Miner. Res. 27: 2231-2237, 2012.
Go to original source...
Go to PubMed...
- LEVEY, A. S., CORESH, J., BALK, E., KAUSZ, A. T., LEVIN, A., STEFFES, M. W., HOGG, R. J., PERRONE, R. D., LAU, J., EKOYAN, G., NATIONAL KIDNEY FOUNDATION: National Kidney Foundation practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Ann. Intern. Med., 139: 137-147, 2003.
Go to original source...
Go to PubMed...
- MEIER, C., KRAENZLIN, M. E., BODMER, M., JICK, S. S., JICK, H., MEIER, C. R.: Use of thiazolidinediones and fracture risk. Arch. Intern. Med., 168: 820-825, 2008.
Go to original source...
Go to PubMed...
- MELTON 3rd, L. J., LEIBSON, C. L., ACHENBACH, S. J., THERNEAU, T. M., KHOSLA, S.: Fracture risk in type 2 diabetes: update of a population-based study. J. Bone Miner. Res., 23: 1334-1342, 2008.
Go to original source...
Go to PubMed...
- MIYATA, T., NOTOYA, K., YOSHIDA, K., HORIE, K., MAEDA, K., KUROKAWA., K., TAKETOMI, S.: Advanced glycation end products enhance osteoclast-induced bone resorption in cultured mouse unfractionated bone cells and in rats implanted subcutaneously with devitalized bone particles. J. Am. Soc. Nephrol., 8: 260-270, 1997.
Go to original source...
Go to PubMed...
- MOLINUEVO, M. S., SCHURMAN, L., MCCARTHY, A. D., CORTIZO, A. M., TOLOSA, M. J., GANGOITI, M. V., ARNOL, V., SEDLINSKY, C.: Effect of metformin on bone marrow progenitor cell differentiation: in vivo and in vitro studies, J. Bone Miner. Res., 25: 211-221, 2010.
Go to original source...
Go to PubMed...
- MOSEKILDE, L.: Vitamin D and the elderly. Clin. Endocrinol., 62: 265-281, 2005.
Go to original source...
Go to PubMed...
- NORRIS, R., PARKER, M.: Diabetes mellitus and hip fracture: A study of 5966 cases. Injury, 42: 1313-1316, 2011.
Go to original source...
Go to PubMed...
- PAUL, R. G., BAILEY, A. J.: Glycation of collagen: the basis of its central role in the late complications of ageing and diabetes. Int. J. Biochem. Cell Biol., 28: 1297-310, 1996.
Go to original source...
Go to PubMed...
- PSCHERER, S., FREUDE, T., FORST, T., NÜSSLER, A. K., BRAUN, K. F., EHNERT, S.: Anti-diabetic treatment regulates pro-fibrotic TGF-beta serum levels in type 2 diabetics, Diabetol. Metab. Syndr., 5: 48, 2013.
Go to original source...
Go to PubMed...
- SRIKANTHAN, P., CRANDALL, C. J., MILLER-MARTINEZ, D., SEEMANN, T. E., GREENDALE, G. A., BRINKLEY, N., KARLAMANGLA, A. S.: Insulin resistance and bone strength: findings from the study of midlife in the United States. J. Bone Miner. Res., 29: 796-803, 2014.
Go to original source...
Go to PubMed...
- VESTERGAARD, P.: Discrepancies in bone mineral density and fracture risk in patients with type 1 and type 2 diabetes-a meta-analysis. Osteoporos. Int., 18: 427-444, 2007.
Go to original source...
Go to PubMed...
- VESTERGAARD, P., REJNMARK, L., MOSEKILDE, L.: Relative fracture risk in patients with diabetes mellitus, and the impact of insulin and oral antidiabetic medication on relative fracture risk, Diabetologia, 48: 1292-1299, 2005.
Go to original source...
Go to PubMed...
- VILLAFAN-BERNAL, J. R., SANCHEZ-ENRIQUEZ, S., MUNOZ-VALLE, J. F.: Molecular modulation of osteocalcin and its relevance in diabetes (Review). Int. J. Mol. Med. 28:283-293, 2011.
- VOGT, M. T., CAULEY, J. A., TOMAINO, M. M., STONE, K., WILLIAMS, J. R., HERNDON, J. H.: Distal radius fractures in older women: a 10-year follow-up study of descriptive characteristics and risk factors. The study of osteoporotic fractures. J. Am. Geriatr. Soc., 50: 97-103, 2002.
Go to original source...
Go to PubMed...
- WARRINER, A. H., PATKAR, N. M., YUN, H., DELZELL, E.: Minor, Major, Low-Trauma, and High-Trauma Fractures: What Are the Subsequent Fracture Risks and How Do They Vary?, Curr. Osteoporos. Rep. 9: 122-128, 2011.
Go to original source...
Go to PubMed...
- WILD, S., ROGLIC, G., GREEN, A., SICREE, R., KING, H.: Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care, 27: 1047-1053, 2004.
Go to original source...
Go to PubMed...
- ZINMAN, B., HAFFNER, S. M., HERMAN, W. H., HOLMAN, R. R., LACHIN, J. M., KRAVITZ, B. G., PAUL, G., JONES, N. P., AFTRING, R. P., VIBERTI, G., KAHN, S. E., ADOPT STUDY GROUP: Effect of rosiglitazone, metformin, and glyburide on bone biomarkers in patients with type 2 diabetes. J. Clin. Endocrinol. Metab., 95: 134-142, 2010.
Go to original source...
Go to PubMed...