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Effects of Aging on Fracture Healing

  • Orthopedic Management of Fractures (S Bukata and L Gerstenfeld, Section Editors)
  • Published:
Current Osteoporosis Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

This review summarizes research on the physiological changes that occur with aging and the resulting effects on fracture healing.

Recent Findings

Aging affects the inflammatory response during fracture healing through senescence of the immune response and increased systemic pro-inflammatory status. Important cells of the inflammatory response, macrophages, T cells, mesenchymal stem cells, have demonstrated intrinsic age-related changes that could impact fracture healing. Additionally, vascularization and angiogenesis are impaired in fracture healing of the elderly. Finally, osteochondral cells and their progenitors demonstrate decreased activity and quantity within the callus.

Summary

Age-related changes affect many of the biologic processes involved in fracture healing. However, the contributions of such changes do not fully explain the poorer healing outcomes and increased morbidity reported in elderly patients. Future research should address this gap in understanding in order to provide improved and more directed treatment options for the elderly population.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, University of California at San Francisco, 513 Parnassus Ave., San Francisco, CA, 94143, USA

    Dan Clark, Ted Miclau & Ralph Marcucio

  2. Orthopaedic Trauma Institute, Zuckerberg San Francisco General Hospital and Trauma Center, 2550 23rd St, Building 9, San Francisco, CA, 94110, USA

    Dan Clark, Ted Miclau & Ralph Marcucio

  3. Department of Oral and Craniofacial Sciences, School of Dentistry, University of California at San Francisco, 513 Parnassus Ave., Rm. S-619A, San Francisco, CA, 94143, USA

    Dan Clark

  4. Department of Medicine, University of California at San Francisco, San Francisco, CA, 94143-0451, USA

    Mary Nakamura

  5. Department of Pathology, VA Medical Center, University of California San Francisco & Pathology Service, San Francisco, CA, 94121, USA

    Mary Nakamura

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  1. Dan Clark
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  3. Ted Miclau
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Correspondence to Ralph Marcucio.

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Conflict of Interest

Daniel Clark, Mary Nakamura, and Ralph Marcucio declare no conflict of interest. This work was funded by NIH/NIA R01AG046282.

Theordore Miclau reports grants and personal fees from the Foundation for Orthopedic Trauma, grants from National Institutes of Health and Baxter, and personal fees from Depuy-Synthes, Acelity, Surrozen, and Arquos outside the submitted work.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Orthopedic Management of Fractures

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Clark, D., Nakamura, M., Miclau, T. et al. Effects of Aging on Fracture Healing. Curr Osteoporos Rep 15, 601–608 (2017). https://doi.org/10.1007/s11914-017-0413-9

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