Clinical Reviews in Bone and Mineral Metabolism

, Volume 16, Issue 4, pp 116–130 | Cite as

Systemic Bone Loss After Fracture

  • Benjamin OsipovEmail author
  • Armaun J. Emami
  • Blaine A. Christiansen
Part of the following topical collections:
  1. Fracture


A history of prior fracture is the most reliable indicator of prospective fracture risk. Increased fracture risk is not confined to the region of the prior fracture but is operant at all skeletal sites, providing strong evidence of systemic bone loss after fracture. Animal and human studies suggest that systemic bone loss begins shortly after fracture and persists for several years in humans. In fact, bone quantity and bone quality may never fully return to their pre-fracture levels, especially in older subjects, demonstrating a need for improved understanding of the mechanisms leading to systemic bone loss after fracture in order to reduce subsequent fracture risk. Although the process remains incompletely understood, mechanical unloading (disuse), systemic inflammation, and hormones that control calcium homeostasis may all contribute to systemic bone loss. Additionally, individual factors can potentially affect the magnitude and time course of systemic bone loss and recovery. The magnitude of systemic bone loss correlates positively with injury severity and age. Men may also experience greater bone loss or less recovery than women after fracture. This review details the current understanding of systemic bone loss following fracture, including possible underlying mechanisms and individual factors that may affect this injury response.


Fracture healing Osteoporosis Bone loss Fracture risk 


Funding information

The authors are supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), under award number R01 AR071459.

Compliance with Ethical Standards

Human and Animal Studies

In animal studies cited involving the authors, all applicable international, national, and/or institutional guidelines for the care and use of animals were followed. This article does not contain any studies with human participants performed by any of the authors.

Conflict of Interest

The authors declare that they have no conflict of interest.


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© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Lawrence J. Ellison Musculoskeletal Research Center, Department of Orthopaedic SurgeryUniversity of California Davis Medical CenterSacramentoUSA

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