Calcium And Vitamin D For Fracture Healing

Highlights

•: A comprehensive review on the cellular and clinical effect of vitamin D in human fracture healing.
•: Vitamin D affects fracture involved inflammatory cells, cytokines, growth factors, osteoblasts, osteoclasts and the process of mineralization.
•: Clinical research on the effects of vitamin D deficiency and supplementation on fracture healing is scarce and remain inconclusive.
•: Vitamin D has a role in fracture healing, but the available research data are too inconsistent to elucidate the details of that role.

Abstract

Introduction

Vitamin D is essential for bone mineralization and for the subsequent maintenance of bone quality. Mineralization is part of hard callus formation and bone remodelling, processes, which are part of fracture healing. We provide a comprehensive review of the literature to summarize and clarify if possible, the cellular effects of vitamin D and its clinical involvement in the process of fracture healing in human.

Material and methods

We conducted a literature search in PubMed, Embase (OVID version), and Web of Science.

Results

A total of 75 in vitro and 30 in vivo studies were found with inconsistent results about the cellular effect of vitamin D on fracture involved inflammatory cells, cytokines, growth factors, osteoblasts, osteoclasts and on the process of mineralization. With only five in vitro studies performed on material derived from a fracture site and one in vivo study in fracture patients, the exact cellular role remains unclear.

Seven studies investigated the circulating vitamin D metabolites in fracture healing. Although it appears that 25(OH)D and 24,25(OH)₂D₃ are not affected by the occurrence of a fracture, this might not be the case with serum concentrations of 1,25(OH)₂D₃. The potential clinical effect of vitamin D deficiency is only described in one case series and three case controlled studies, where the results tend to show no effect of a vitamin D deficiency.

No clinical studies were found investigating solely vitamin D supplementation. Two clinical studies found a positive effect of vitamin D supplementation and calcium, of increased bone mineral density or respectively increased fracture callus area at the fracture site. One study found indirect evidence that vitamin D and calcium promoted fracture healing.

Conclusion

Despite these results, and the presumed beneficial effect of vitamin D supplementation in deficient patients, clinical studies that address the effects of vitamin D deficiency or supplementation on fracture healing are scarce and remain inconclusive. We conclude that vitamin D has a role in fracture healing, but the available data are too inconsistent to elucidate how and in what manner.

Abbreviations

TNF-α

Tumor Necrosis Factor-alpha

TGF-β

Transforming Growth Factor beta

IGF

Insulin-Like Growth Factor

BMP's

Bone Morphogenetic Proteins

VEGF

Vascular Endothelial Growth Factor

FGF

Fibroblast Growth Factor

PDGF

Platelet-Derived Growth Factor

TNAP

Tissue-Nonspecific Alkaline Phosphatase

Keywords

Vitamin D

Calcidiol

Vitamin D deficiency

Fracture

Fracture healing

Bone

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Calcium And Vitamin D For Fracture Healing

Source: https://www.sciencedirect.com/science/article/pii/S8756328214001616

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Calcium And Vitamin D For Fracture Healing