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Fracture Healing in the Setting of Endocrine Diseases, Aging, and Cellular Senescence
Open accessAbstract
More than 2.1 million age-related fractures occur in the United States annually, resulting in an immense socioeconomic burden. Importantly, the age-related deterioration of bone structure is associated with impaired bone healing. Fracture healing is a dynamic process which can be divided into four stages. While the initial hematoma generates an inflammatory environment in which mesenchymal stem cells and macrophages orchestrate the framework for repair, angiogenesis and cartilage formation mark the second healing period. In the central region, endochondral ossification favors soft callus development while next to the fractured bony ends, intramembranous ossification directly forms woven bone. The third stage is characterized by removal and calcification of the endochondral cartilage. Finally, the chronic remodeling phase concludes the healing process. Impaired fracture healing due to aging is related to detrimental changes at the cellular level. Macrophages, osteocytes, and chondrocytes express markers of senescence, leading to reduced self-renewal and proliferative capacity. A prolonged phase of “inflammaging” results in an extended remodeling phase, characterized by a senescent microenvironment and deteriorating healing capacity. Although there is evidence that in the setting of injury, at least in some tissues, senescent cells may play a beneficial role in facilitating tissue repair, recent data demonstrate that clearing senescent cells enhances fracture repair. In this review, we summarize the physiological as well as pathological processes during fracture healing in endocrine disease and aging in order to establish a broad understanding of the biomechanical as well as molecular mechanisms involved in bone repair.
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“Dysregulated inflammation, as seen in cases of advanced age, diabetes, obesity, and autoimmune disease, is often associated with non-union, delayed healing, and other complications [1–3].”
From Osteoimmunology of Fracture Healing. (2024) · cites this paper as [3]
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“In general, this work in addition to that of others indicates pro-inflammatory cytokines such as IL-1β, IL-6, IFNγ, TNFα, and C-reactive protein (CRP) are more highly expressed in aged patients and associated with an increased risk for fracture [3, 51•, 82, 90, 91].”
From Osteoimmunology of Fracture Healing. (2024) · cites this paper as [3]
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“In studies using aged mice, lowering the level of M1 macrophages led to improved fracture healing [3, 87].”
From Osteoimmunology of Fracture Healing. (2024) · cites this paper as [3]
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“Platelets secrete PDGF, VEGF, TGFβ, and IGF-1 to promote mesenchymal progenitor cell proliferation and differentiation [3, 37].”
From Osteoimmunology of Fracture Healing. (2024) · cites this paper as [3]
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“B cells are prolific cytokine producers in the fracture callus; they express IL-10 to limit proinflammatory signaling and to reduce the early inflammatory response [3].”
From Osteoimmunology of Fracture Healing. (2024) · cites this paper as [3]
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BackgroundResultInfluential
Metadata
- Authors
- Saul, D., & Khosla, S.
- Affiliations
- Mayo Clinic (US)
- Corresponding author
- Khosla, Sundeep
- Venue
- Endocrine Reviews
- Publisher
- The Endocrine Society
- Published
- 2022-02-19
- Volume
- 43
- Issue
- 6
- Pages
- 984-1002
- ISSN
- 0163-769X (ISSN-L)
- 1945-7189
- PMC
- PMC9695115
- OpenAlex
- W4213167559
- Cited by
- 185
- References
- 249
- Citations by year
- 2026: 55 · 2025: 65 · 2024: 47 · 2023: 16 · 2022: 2
- FWCI
- 5.16
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Endocrine Reviews (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (AG062413, AG065868)
- German Research Foundation (413501650)
- Deutsche Forschungsgemeinschaft
- Topics
- Health Sciences › Medicine › Orthopedics and Sports Medicine › Bone fractures and treatments
- Health Sciences › Medicine › Orthopedics and Sports Medicine › Bone health and osteoporosis research
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Bone Metabolism and Diseases
- Keywords
- fracture healing, endocrine disorders, aging, cellular senescence, inflammaging, endochondral ossification, intramembranous ossification, mesenchymal stem cells, macrophages, osteocytes, chondrocytes, senolytics, bone remodeling, hematoma, angiogenesis, chondrogenesis
- MeSH terms
- Aging, Bony Callus, Endocrine System Diseases, Humans, Osteogenesis, Cellular Senescence, Fracture Healing, Fractures, Bone
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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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