Inflammation and Broken Bones

by Cindy Gray

Emergency departments in hospitals across the U.S. are kept busy dealing with broken bones and fractures. Figures released by the American Academy of Orthopedic Surgeons reports that one in every two Americans will sustain a fracture before they reach the age of 65. This risk is several times higher than the likelihood of them suffering a stroke, prostate cancer, breast cancer or even type-2 diabetes.Inflammation and Fractures

Fractures usually require orthopedic treatment and in many cases this means surgery, casting, bracing, hospitalization and loss of income.

Two groups were at particularly high risk of fractures: children aged 10 to 14 (1 in every 37 boys and 1 in every 62 girls), and women over the age of 65. Studies into the incidence of fractures in older women looked at whether hip fractures and non-traumatic fractures could be related to the presence of inflammatory markers known as cytokines.

Inflammation and Bone Loss

Cytokines are groups of proteins, peptides and glycoproteins that are secreted from cells within the immune system. They are a useful way of measuring inflammation which is thought to be a factor in the development of osteoporosis.

This is significant in terms of fractures as it appears that the presence of inflammatory markers may indicate a faster than normal bone loss. This may lead to osteoporosis, particularly in postmenopausal women, and could therefore be associated with a higher risk of a fracture and eventual disability in the long-run. 

Other risk factors for bone loss and hip fractures include smoking, lower body weight, lower levels of physical activity, lower serum estradiol and higher levels of serum adiponectin.

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Study into Inflammatory Markers and the Risk of Fracture

Studies have shown that women are more likely to suffer from osteoporotic fractures of the hip, spine, forearm and humerus than men at a ratio of 70:30. White women are also known to be twice as likely as Asian or Black women to suffer a hip fracture in later life.

Hip fractures are the most serious as they have an impact on morbidity and mortality. The one-year mortality rate for a woman who has suffered a hip fracture is 17-22%, suggesting that it hastens a decline in their lifespan.

Researchers at the University of Pittsburgh Department of Epidemiology studied the cases of 400 women with physician adjudicated incident hip fractures and 400 control women who had not had a previous hip fracture and were not using estrogen or any bone-active medications. The women were aged 50-79 years and the trial lasted over seven years. The subjects who had previously suffered a fracture generally had higher markers of inflammation than those who had no history of bone fractures.

The studies found that women with the highest amount of inflammation, identified as having higher levels of cytokines (pre-inflammatory markers), were almost three times more likely to suffer a non-traumatic or hip fracture than those with one or less inflammatory markers in the highest quartile.

Doctors are increasingly recognizing the role of the immune system and the presence of cytokines in assessing the risk of osteoporosis and fractures. Future clinical trials are necessary to see whether it is possible to decrease inflammatory markers in order to reduce hip fractures, improving the quality of life for many older women.

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