Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2018 Oct 31;10(11):1597.
doi: 10.3390/nu10111597.

Malnutrition and Fracture Healing: Are Specific Deficiencies in Amino Acids Important in Nonunion Development?

Dennis M Meesters  1   2 , Karolina A P Wijnands  3   4 , Peter R G Brink  5 , Martijn Poeze  6   7
Affiliations
Review

Malnutrition and Fracture Healing: Are Specific Deficiencies in Amino Acids Important in Nonunion Development?

Dennis M Meesters et al. Nutrients. .

Abstract

With the increasing incidence of fractures now, and in the future, the absolute number of bone-healing complications such as nonunion development will also increase. Next to fracture-dependent factors such as large bone loss volumes and inadequate stabilization, the nutritional state of these patients is a major influential factor for the fracture repair process. In this review, we will focus on the influence of protein/amino acid malnutrition and its influence on fracture healing. Mainly, the arginine-citrulline-nitric oxide metabolism is of importance since it can affect fracture healing via several precursors of collagen formation, and through nitric oxide synthases it has influences on the bio-molecular inflammatory responses and the local capillary growth and circulation.

Keywords: arginine; citrulline; fracture healing; nitric oxide; nitric oxide synthase; nonunion.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Schematic representation of the arginine-citrulline-nitric oxide metabolism. Arginine can be converted into citrulline by one of the isoforms of nitric oxide synthase (NOS1, NOS2 and NOS3). During the conversion, nitric oxide is produced. Citrulline can be converted back into arginine by the enzymes arginosuccinate synthetase (ASS) and arginosuccinate lyase (ASL). Conversion of arginine into ornithine is mainly via arginase 1 (Arg1). Ornithine acts as a precursor for collagen synthesis through conversion via several polyamine molecules. Along a second route, it can be converted into citrulline by the enzyme ornithine transcarbamylase (OTC).
See this image and copyright information in PMC

References

    1. Kannus P., Niemi S., Palvanen M., Parkkari J., Pasanen M., Jarvinen M., Vuori I. Continuously rising problem of osteoporotic knee fractures in elderly women: Nationwide statistics in Finland in 1970–1999 and predictions until the year 2030. Bone. 2001;29:419–423. doi: 10.1016/S8756-3282(01)00602-0. - DOI - PubMed
    1. van Staa T.P., Dennison E.M., Leufkens H.G., Cooper C. Epidemiology of fractures in England and Wales. Bone. 2001;29:517–522. doi: 10.1016/S8756-3282(01)00614-7. - DOI - PubMed
    1. Johnell O., Kanis J. Epidemiology of osteoporotic fractures. Osteoporos. Int. 2005;16(Suppl. 2):S3–S7. doi: 10.1007/s00198-004-1702-6. - DOI - PubMed
    1. Alves C.J., Neto E., Sousa D.M., Leitao L., Vasconcelos D.M., Ribeiro-Silva M., Alencastre I.S., Lamghari M. Fracture pain-Traveling unknown pathways. Bone. 2016;85:107–114. doi: 10.1016/j.bone.2016.01.026. - DOI - PubMed
    1. Knuth A.G., Hallal P.C. Temporal trends in physical activity: A systematic review. J. Phys. Act. Health. 2009;6:548–559. doi: 10.1123/jpah.6.5.548. - DOI - PubMed