Fracture as a predictor of bone mass loss: pathogenetic aspects and potential methods of treatment

Abstract

The article contains a review of the existing literature on systemic bone mass loss immediately after bone fractures. As a result of such fractures, skeletal bones become more brittle. In addition, fractures have impact on the mechanical bone properties which is considered as a risk factor of future fractures of any location, indicating systemic bone mass loss. Bone mass loss begins soon after a bone is broken in any site of the body and persists for several years. In fact, the quality and mineral density of bone tissue will never return to the baseline, especially in elderly people, while the intensity of bone mass loss correlates with the injury severity and age. It is commonly believed that bone fractures are most often affect post-menopausal women. However, bone mass losses in men are more pronounced and recover slower than in women. It is still assumed that such factors as genetic predisposition, diet characteristics, comorbidities, medications (primarily glucocorticoids), lack of physical activity, systemic inflammation and disorders of calcium-homeostasis-regulating hormones contribute to the progression of bone mass losses. Similarly to bone remodeling in the healthy skeletal tissue, the bone regeneration after fractures is a complex process, where the key role is played by the cytokine system comprising receptor activator of nuclear factor-kappa B, its ligand and osteoprotegerin. The article describes the process of bone reconstruction regulation amid the systemic bone mass loss shortly after a fracture and identifies the main factors which may have impact on the amount of systemic bone mass losses. KEYWORDS: fracture, mineral density of bone tissue, osteoporosis, remodeling, mineral metabolism, cytokines, RANKL/RANK/OPG. FOR CITATION: Aganov D.S., Toporkov M.M., Svintsitskaya I.S. et al. Fracture as a predictor of bone mass loss: pathogenetic aspects and potential methods of treatment. Russian Medical Inquiry. 2023;7(3):160–166 (in Russ.). DOI: 10.32364/2587-6821-2023-7-3-160-166.