Manipulating Bone Healing by Drugs

Drug treatment has become one of the most important cornerstones of modern medicine, successfully influencing the course of many diseases. But in orthopedic surgery, drugs are still used surprisingly seldom.

Technical advances like new fracture fixation devices and joint prostheses have revolutionized the lives of many orthopedic surgery patients. But, even today, some patients experience fractures that fail to heal, despite numerous operations, the most modern fracture devices, or bone transplants. Limb amputations are sometimes the only remaining solution in some of the most severe cases of fractures that do not knit together.

Me and my fellow researchers believe that we can offer biological help in both fracture healing and in other diseases affecting bone.

There are two main cell types in the bone involved during the healing of a fracture.

Osteoclasts are specialized cells involved in resorption the breakdown and cleanup of dead bone in a fractured area so that new bone can be laid down. Osteoblasts are the cells responsible for the production of the new bone. A collaboration and a balance between the two are required, both for a swift response to a fracture, as well for maintenance of a functioning skeleton.

Delayed healing or lack of healing of a fracture can be caused by either a failure in the response of the osteoblasts resulting in a deficiency in bone formation or by increased resorption activity of the osteoclasts, such as in infections or instability. Sometimes delayed fracture healing is a combined effect of both.

The amount of snow remaining in the fields the day after a snowstorm depends not only on how much snow has fallen, but also on how much snow melted away during the night. In bone, both the precipitation and the melting can now be manipulated by drugs.

Bisphosphonates are a class of drugs that are mainly used in the treatment of osteoporosis. These drugs are taken up exclusively by osteoclasts, causing these cells to die and thus delaying bone resorption.

In fracture healing, our research group has shown that bisphosphonates lead to the retention of the newly formed bone healing tissue and thus to a stronger bone repair. Bisphosphonates cannot alone initiate bone healing, but they can delay resorption of what has been formed. In other words, bisphosphonates decrease the melting, but not the precipitation.

Bone morphogenic proteins (BMP) are naturally occurring proteins capable of initiating bone formation. These proteins are involved in many biological processes but were first described in bone, where, as a response to trauma and fracture, bone morphogenic proteins initiate recruitment and proliferation of bone progenitor cells that develop into functioning, bone-producing osteoblasts.

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Manipulating Bone Healing by Drugs