July 2010 Newsletter

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Healthy ways to help heal broken bones
By Dr. Stephen A. Hunt

In many instances, broken bones will heal without any significant problems. Occasionally broken bones will need to be held in place by a cast or sometimes stabilized by an operation, to achieve the most optimal outcome. Broken bones heal with a well-studied and predictable sequence of biologic events, but there are some simple lifestyle modifications that can improve the chance of a broken bone healing without any problems.

Smoking Cessation
Preventing bones from healing is just one of the many negative effects of smoking. Nicotine, the addictive substance in cigarettes, has been shown to inhibit fracture healing. Additionally, it is associated with an increase in complications after surgery for broken bones. Smoking related complications include the breakdown of wounds, infection, and non-union (the ends of the broken bone do not come together to heal). Even as little as two cigarettes per day can compromise bone healing after an operation.

Clinical trials of patients with fractures have shown that stopping smoking at the time of a fracture, or surgery for a fracture will decrease the risk for any of these complications. Fracture patients should cut back, or more importantly STOP, smoking to promote bone health.

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
NSAIDS, such as ibuprofen, naproxen, and celebrex, have been demonstrated to inhibit fracture healing and bone fusion. Inflammation is a crucial part of the early healing process of a broken bone. Specifically, when a bone is broken, bleeding at the injury occurs and this blood forms a clot that then undergoes a predictable process of inflammation and remodeling to heal the bone.

NSAIDS are commonly used in acute injuries to control swelling and pain. However, NSAIDs in high doses have been shown to be detrimental to fracture healing during the first few weeks of the injury. Once stopped, these medications quickly lose their effect. For most people, an occasional NSAID will NOT have a major impact on their healing fracture. In children, bone remodeling tends to be quicker and therefore NSAIDs are not of as much concern as in adults with other medical problems. In general, patients should avoid NSAIDs as the primary pain reliever in adults with acute (less than three weeks old) fractures and instead stick to Tylenol based pain relievers.

Calcium
Calcium is an essential part of bone matrix. Therefore, it is essential to have a healthy daily intake of calcium for the healing bone. There is no evidence that taking more than the daily-recommended amount of Calcium (around 1000 mg for most adults) will speed up bone healing or prevent the fracture from not healing. In older patients with osteoporosis, calcium supplementation (along with Vitamin D) may help prevent future fractures. Therefore, a healthy diet that has an adequate amount of calcium is all that people need. Supplements should only be taken if your diet is deficient in calcium or vitamin D.

REFERENCES:

1. Nasell H et al. Effect of smoking cessation intervention on results of acute fracture surgery: a randomized controlled trial. J Bone Joint Surg (Am) 2010; 92: 1335-42.
2. Sloan et al. The effects of smoking on fracture healing. Surgeon 2010; 8: 111-6.
3. Dodwell ER et al. NSAID exporsure and risk of Nonunion: a meta-analysis of case-control and cohort studies. Calcif Tissue Int 2010.
4. Abdul-Hadi O et al. Nonsteroidal anti-inflammatory drugs in orthopedics. J Bone Joint Surg Am 2009; 91: 2020-7.
5. Bouxsein ML et al. Recommendations for optimal care of the fragility fracture patient to reduce the risk of future fracture. J Amer Acad Orthop Surg 2004; 12: 385-95.