[Frontiers in Bioscience 19, 1162-1175, June 1, 2014]

Fracture healing: From basic science to role of nutrition

Maria Gabriella Giganti1, Ilaria Tresoldi1, Laura Masuelli2, Andrea Modesti1, Giuseppe Grosso3, Federico Maria Liuni1, Monica Celi1, Cecilia Rao1, Elena Gasbarra1, Roberto Bei1, Umberto Tarantino1

1Dept. of Clinical Sciences and Translational Medicine, University of Rome "Tor Vergata", Italy, 2Dept. of Experimental Medicine, University of Rome "Sapienza", Italy; 3Dept. of Clinical and Molecular Biomedicine, University of Catania, Catania, Italy


1. Abstract
2. Introduction
3. Bone fracture healing
4. Fragility fractures
5. Physiological inflammatory process and impairment in the osteoporotic patient
6. Molecular cooperation
7. Nutritional factors and bone quality
8. Concluding remarks
9. References


Fracture healing is a complex event that involves the coordination of different processes: initial inflammatory response, soft and hard callus formation, initial bony union and bone remodeling. This well-orchestrated series of biological events follows a specific temporal and spatial sequence that can be affected by biological factors, such as age and bone quality. There is some evidence that increased age is a considerable factor in the inhibition of fracture repair in human subjects. During aging there is an accumulation of damage that depends on the activation of inflammation processes and on changes in the circulating levels of inflammatory cytokines. In addition to the physiological slow down in the repair process, other conditions such as multiple comorbidities leading to polymedication are a frequent occurrence in elderly patients and can have an influence on this process. A further factor that affects bone metabolism is nutrition: bone quality, fragility fractures risk and fracture healing process are all influenced by the nutritional status. This review provides a summary of the immunological aspects of physiological fracture healing and of those nutritional factors which might play an important role in this process.