Injury
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Osteoporosis is a worldwide public health issue and with the aging population the resultant increase in fragility fractures has generated a significant socioeconomic impact. Robust scientific research has increased our knowledge of the endocrine mechanisms and pathophysiology of osteoporosis. This information has led to Level 1 randomized clinical trials which demonstrate the beneficial effects of appropriate regimens in reducing the fracture risk and the coincident mortality. ⋯ This has been emphasized in the worldwide efforts in orthopedic surgery such as the "Bone and Joint Decade" and "Own the Bone" programs. This commitment to bone health and restoration is important. Our patients deserve no less.
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Despite improvements in implants and surgical techniques, osteoporotic fractures remain challenging to treat. Among other major risk factors, decreased expression of morphogenetic proteins has been identified for impaired fracture healing in osteoporosis. Bone grafts or bone graft substitutes are often used for stabilizing the implant and for providing a scaffold for ingrowth of new bone. ⋯ Limited data on animal experiments suggest stimulation of fracture healing in ovariectomized rats by the use of BMPs. In conclusion, there is only limited data on the clinical relevance and optimal indications for the use of bone graft substitute materials and BMPs on the treatment of osteoporotic fractures despite the clinical benefits of these materials in other clinical indications. Given the general compromised outcome in osteoporotic fractures and limited alternatives for enhancement of fracture healing, clinicians and researchers should focus on this important topic and provide more data in this field in order to enable a sound clinical use of these materials in osteoporotic fractures.