The fracture healing diet. Can nutritional supplements enhance osteogenic potential and fracture healing? A scoping review of current literature.

Abstract

Nutrition influences bone health. Targeted nutritional supplementation could potentially improve osteogenic potential and therefore support fracture healing. This review gives an overview of different nutritional supplements and their effect on fracture healing and osteogenic differentiation. The aim is to identify promising supplements for further research and clinical applications. A systematic search was conducted in PubMed, EMBASE and SCOPUS. All in vivo studies (human and animal) that investigated the effect of oral nutritional supplementation on fracture healing or osteogenic cell differentiation were included. Studies regarding osteoporosis were excluded. Articles were screened and selected by two independent researchers. The PRISMA-guidelines were followed for the execution of this study. The outcomes of each study were narratively reviewed after inclusion. Fifty-nine of the 7709 screened articles were included. Included studies were categorized into seven different food groups: Proteins and amino acids (n = 13), plant-derived nutrients and polyphenols (n = 19), minerals and salts (n = 12), vitamins (n = 9), fats (n = 2) and other (n = 4). 67.3% of included studies showed promising results regarding osteogenic differentiation or fracture healing. However, no definitive conclusions can be drawn from these studies, due to the small sample sizes and heterogeneity between the studies. This review provides a comprehensive overview of the current in vivo evidence on nutritional supplementation in osteogenic differentiation and fracture healing. It highlights several promising nutrients, such as amino acids like citrulline, protein supplements, fruit and vegetable extracts, and flavonoids, that merit further clinical investigation. In (complex) fracture care, nutritional supplementation could add to personalized and cost-effective fracture care.