Bone fractures are among the most common orthopedic problems happen to many of us. Although our body will naturally repair broken bone, the healing process takes weeks, months, or even years depending on severity of injury and complications. Even worse cases, elderly, smoker patients and patients with metabolic diseases such as osteoporosis or diabetes have much longer healing time and higher risk of developing nonunion (non-healing of the bone). Fortunately, we can make a significant augmentation during the recovery process simply by working with nature. There are many different herbal remedies for speeding bone healing including arnica, wild comfrey, bone-set; and numerous effective ingredients was isolated from those herbs. Herbal therapy not only helps fracture repair but also strengthen bones and lessen the chances of bone fragility. Here we introduce another promising herb ingredient that can help to heal broken bones.
Fig. 1. Oral administration of osthole accelerated fracture healing process in mice. Mice received femur osteotomy were orally administrated with vehicle solvent or 20 mg/kg of osthole daily from postoperative week 1 to 4. Representative serial radiographs of fracture healing process in control and osthole-treated group was shown. Dotted line: Region of Interest (ROI) of callus for quantitative analysis.
Osthole is a naturally derived coumarin, which is the main bioactive compound isolated from medicinal plant Cnidium monnieri (L.) Cusson. This herb is commonly used as one component in herbal formulas for bone strengthening by traditional Chinese medicine practitioners. In this study, we investigated the effect of osthole on bone fracture repair using femoral open fracture model in mice. A transverse fracture was created at the middle of femur with saw. Operated mice were given with 20 mg/kg osthole solution or solvent alone by oral gavage every day since postoperative week 1. Bone healing process of both groups was assessed by commonly used techniques like plain radiography, micro-computed tomography, histology analysis as well as molecular imaging showing bone regeneration.
Fracture healing can be divided into three stages including inflammation phase, reparative phase and remodeling. During reparative phase, fracture ends are firstly joined together by soft (fibrocartilage) callus, and then the soft tissues are calcified into woven bone from periphery of callus into central fracture site and form a more mechanically resistant hard (bony) callus. Finally, low mineral density woven bone is gradually remodeled into highly dense cortical bone during remodeling phase. Through in vivo (in living animals) radiographic and molecular imaging results and ex vivo (outside living animals) micro-computed tomography, histological results, we found that the bony callus formation was significantly faster and the whole reparative phase was much shorter in osthole fed mice. Plain radiography allowed monitoring callus morphology in living mouse during fracture repair. As shown in the figure, clear callus contour could be defined from week 2, quantitative analysis of region of interest (ROI) of callus estimated the size and mineral content in callus. In osthole-treated group, and the bone content in callus at week 2 was significantly higher than that in control group. Moreover the callus size at week 3 was apparently reduced compared to size at week 2, which was much smaller than control, suggesting transition from reparative phase to remodeling phase.
In summary, oral intake of osthole promotes bone formation during reparation phase and hence accelerates the whole bone fracture healing process. Os thole may be another promising natural supplement that facilitates bone healing and benefits bone health.
Fracture is defined as complete or incomplete separation in the continuity of bone Fracture healing is a complex physiological process that involves the coordinated participation of hematopoietic and immune cells within bone marrow. It conjunction with vascular and skeletal cell precursors it also includes mesenchymal stem cells which are recruited from the circulation and the surrounding tissues. It is estimated that 80% of the population in developing countries still rely on the traditional herbal medicines. Healing is practiced by people from all levels of society, who live and work in intimate relation with their environment. They range from bone setting, treatment of snake bite and mental disorders. Knowledge of Medicinal plants and their identification should be gain with the help of cowherds, hermits, hunters, forest dwellers and those who gather plants of forest for food. Sushruta Tami Sutrasthanam 36 V.10. Herbs can effective in reducing swelling pain and soreness of the fracture and al so speedy recovery of function. In last few decades there has been growing In alternative forms of therapy globally. Herbal medicines are currently in demand and their popularity is increasing.Keywords: Bone healing, herbal remedies for bone healing, medicinal plant
Healing Broken Bones as Quickly as Possible
6 Ideas to Speed Bone Healing After Injury
Fractures, broken bones—you can call it what you wish, they mean the same thing—are among the most common orthopedic problems; about 7.9 million broken bones come to medical attention each year in the United States.1
Despite what you may have heard, a broken bone is not worse than a fracture: They both mean the same thing. In fact, the word fracture, according to the Oxford English Dictionary, is defined as “the act of being broken.” There are different types of fractures and broken bones, but these words are one and the same and can be caused in various ways. And, although the healing process seems slow, there are several factors you can focus on to make sure you give yourself the opportunity for the best recovery possible.
How Fractures Occur
Fractures occur because an area of bone is not able to support the energy placed on it (quite obvious, but it becomes more complicated). Therefore, there are two critical factors in determining why a fracture occurs: the energy of the event and the strength of the bone.2
The energy can be sudden, high-energy (e.g. car crash), or chronic, low-energy (e.g. stress fracture). The bone strength can either be normal or decreased (for example, weak bone is seen in patients with osteoporosis).3 A very simple problem, the broken bone, just became a whole lot more complicated!
Therefore, fractures most often result from a force such as a car crash or a fall from a height, or in abnormally weak bones such as those in elderly individuals with osteoporosis. The reason why the fracture occurred is often helpful in determining the best treatment for the injury.
Most Common Broken Bones
Orthopedic surgeons treat fractures throughout the skeletal frame, except for the skull (neurosurgeon) and face (ENT, or ear, nose, and throat surgeon). Extremity fractures are most common,4 and usually occur in men younger than age 45, and then become more common in women over age 45.
After this age, women have a more rapid loss of bone density and a likelihood of developing bone thinning. This is why women are particularly susceptible to osteoporosis and subsequent fractures.
The most common fracture prior to age 75 is a wrist fracture. In those over age 75, hip fractures become the most common broken bone.
Healing Broken Bones
Healing a broken bone takes time, and depends on several factors including patient age, overall health, nutrition, blood flow to the bone, and treatment. Following these six tips may help:
- Stop Smoking. Some of the recommendations in this list may be controversial, or unknown the extent to which they affect bone healing. However, this much is clear: patients who smoke, have a much longer average time to healing, and a much higher risk of developing a nonunion (non-healing of the bone). Smoking alters the blood flow to the bone, and it is that blood flow that delivers the necessary nutrients and cells to allow the bone to heal.5 The number one thing you can do to ensure your recovery from a fracture is not smoke. If you know someone who has a fracture and smokes, find ways to help them quit.
- Eat a Balanced Diet. Healing of bone requires more nutrients that the body needs to simply maintain bone health. Patients with injuries should eat a balanced diet, and ensure adequate nutritional intake of all food groups.6 What we put into our body determines how well the body can function and recover from injury. If you break a bone, make sure you are eating a balanced diet so that your bone has the necessary nutrition to make a full recovery.
- Watch Your Calcium. The focus should be on all nutrients. It’s true that calcium is needed to heal bones, but taking excessive doses of calcium will not help you heal faster. Ensure you are consuming the recommended dose of calcium, and if not, try to consume more natural calcium–or consider a supplement.6 Taking mega-doses of calcium does not help a bone heal faster.
- Adhere to Your Treatment Plan. Your doctor will recommend a treatment, and you should adhere to this. Your doctor may recommend treatments including cast, surgery, crutches, or others. Altering the treatment ahead of schedule may delay your recovery. By removing a cast or walking on a broken bone before your doctor allows, you may be delaying your healing time.
- Ask Your Doctor. There are some fractures that may have treatment alternatives. For example, “Jones” fractures of the foot are a controversial treatment area. Studies have shown these fractures usually heal with immobilization in a cast and crutches. However, many doctors will offer surgery for these fractures because patients tend to heal much faster.7 Surgery creates potential risks, so these options must be weighed carefully. However, there may be options which alter the time it takes for a bone to heal.
- Augmenting Fracture Healing. Most often, external devices are not too helpful in accelerating fracture healing. Electrical stimulation, ultrasound treatment, and magnet have not been shown to accelerate the healing of most fractures.8 However, in difficult situations, these may be helpful to aid in the healing of broken bones.
Everyone wants their bone to heal as quickly as possible, but the truth is that it will still require some time for the injury to recover. Taking these steps will ensure that you are doing everything you can to make your bone recovers as soon as possible.
5 nutritional steps to accelerate fracture healing
People who have had a fracture aren’t often told that they can do anything to make their bones heal faster — at most, they’re told to limit the use of the injured bone or limb (not easy to do if the fracture is in your spine!). But there are a number of methods you can employ to reduce your healing time:
1. Provide the body with adequate energy
Fracture healing requires more energy than you might expect. Thus, it’s appropriate to increase your caloric intake to promote healing. In traumatic fractures of the long bones, for example, there is an immediate increase in metabolic demands that can translate into a caloric demand three times that of normal. While a normally active adult may require 2,500 calories a day, a bedridden, injured patient with multiple fractures may need 6,000 calories per day! If this demand is not met, the healing process is compromised.
2. Increase your protein intake
Bone can be imagined as being somewhat like a sponge made of living protein upon which mineral crystals are embedded. By volume, roughly half of bone is comprised of protein. When a fracture occurs, the body is called upon to gather protein building blocks together to synthesize a new structural bone protein matrix. In addition, protein supplementation increases growth factors like insulin-like growth factor-1 (IGF-1), a polypeptide that exerts a positive effect on skeletal integrity, muscle strength, immune response, and bone renewal. Protein malnutrition or under-nutrition leads to a “rubbery” callus, compared to the rigid calluses of those with adequate or high protein intake. Numerous studies document the acceleration of fracture healing with even a modest 10- to 20-gram increase in protein intake. The benefits of supplemental protein are important to everyone and especially important to those with malnutrition or low baseline protein intake. In fact, among elderly hip fracture patients, poor protein status at the time of fracture predicts fracture outcome. Those with low protein status take longer to heal, and have more complications, including death.
Specific amino acids of special importance include lysine, arginine, pro line, glycerin, cystitis, and glut-amine. Ly-sine, for example, is known to enhance calcium absorption, increase the amount of calcium absorbed into the bone matrix, and aid in the regeneration of tissue.
3. Increase anti-inflammatory nutrients
Antioxidants repair oxidative damage. When a bone fracture occurs, a remarkable yield of free radicals is generated by the damaged tissues. In particular, this damage occurs as the tightly bound collagen strands running through the mineral phase of bone are forcefully broken. These ruptured collagen strands interact with oxygen-yielding oxygen radical metabolites. These free radicals are associated with inflammation, further breakdown of bone collagen, and excessive bone turnover. In fracture healing, increased free-radical production can overwhelm the natural anti-oxidant defense mechanisms. In such cases, antioxidants — including vitamins E and C, glycogen, and alpha-politic acid — have been suggested to be beneficial in suppressing the destructive effect of oxidant free radicals on whole body systems and improving fracture healing in animal models and cultured human cell lines.
Inflammation is an essential component of the healing process in bone. Although painful, it is an important part of the cleaning-up and rebuilding process. This inflammatory process involves the oxygenation (COX) enzymes COX-1 and COX-2. Many of our standard non-steroidal anti-inflammatory drugs act by inhibiting the COX-1 and COX-2 enzymes—which relieves the pain, but also delays healing. On the other hand, nourishing the body to reduce inflammation naturally speeds healing. Vitamin C, bioflavonoids and flavorless such as quercitin and proanthrocydins, and omega-3 fatty acids naturally soothe the inflammatory process and speed healing.
4. Boost your mineral intake
By weight, bone is roughly 70% minerals (calcium, phosphorus, magnesium, silicon, zinc, etc.) and fracture healing requires available minerals. Most of us under-consume minerals on an everyday basis, so drawing minerals to the healing site can often involve a process of “stealing from Peter to pay Paul.” (See our 20 key bone nutrients for details on average mineral intake.)
5. Enhance vitamin intake
While protein and minerals may be the building blocks, vitamins are the catalysts for many biochemical reactions and are equally important. In fracture healing, we can clearly identify the vital roles of several vitamins including vitamin C, vitamin D, and vitamin K as well as the energy-producing B vitamins, which should all be taken in therapeutic doses:
- VITAMIN C is essential for proper synthesis of the bone collagen protein matrix. It is also one of the most important antioxidants and anti-inflammatory nutrients. In severe vitamin C deficiency, collagen becomes too unstable to function properly, which results in skin lesions and fragile blood vessels with eventual bleeding from all mucous membranes. A tendency to black and blue without reason is most often a sign of sub-clinical vitamin C deficiency. Because of its essential role in bone collagen formation, adequate vitamin C is required for fracture healing. Several animal studies document this fact. For example, a small Turkish rat study showed that vitamin C supplementation accelerated the fracture healing process. A similar, yet larger, Spanish study also documented that rats with higher vitamin C blood levels developed a stronger fracture callus than did those with low blood levels.
- VITAMIN D is the primary regulator of calcium absorption and without adequate vitamin D calcium blood level drops making less calcium available for fracture healing. Studies as early as 1945 documented that low vitamin D levels led to suboptimal fracture healing and the administration of vitamin D accelerated initial fracture callus mineralization. Further, we now know that vitamin D, in conjunction with vitamin K, stimulates the transformation of fracture site stem cells to bone building osteoblasts. Overall, vitamin D is central to fracture healing and vitamin D status has been shown to be an independent predicator of functional recovery after hip fracture.
- VITAMIN K is an essential part of the biochemical processes that bind calcium to bone and it is required for proper formation of the osteocalcin bone protein. In addition, vitamin K helps conserve calcium by reducing the loss of calcium in the urine. Since 1960 it has been noted that vitamin K has a beneficial effect on fracture healing and has a real effect on all collagen tissues, especially bone tissue. Researchers have found that vitamin K is sequestered to the site of fracture resulting in markedly depressed circulating levels of vitamin K in fracture patients. The time taken for the vitamin K blood level to return to normal appears to be influenced by the severity of the fracture.
- VITAMIN B6 is one of the B vitamins that has been linked to fracture healing. Animals deficient in this vitamin fracture more frequently and experience reduced fracture healing. It appears that vitamin B6 modulates the effects of vitamin K on bone through complex biochemical pathways.
Anti-inflammatory nutrients help reduce pain
Where there is pain, there is inflammation — a product of the body’s action to tear down, recycle, and repair damaged tissues. For fracture healing, it is ideal to use nutrients that are both anti-inflammatory and nourishing to new bone growth. Useful anti-inflammatory nutrients include vitamin C, quercitin and other flavonoids, omega-3 fatty acids, and proteolytic enzymes such as bromalain and trypsin.
Multi-nutrient therapy is the likely best approach
Bone is complex tissue that requires many nutrients. Given this fact, supplementation with a wide range of key bone nutrients is likely to provide more effective fracture healing than individual nutrient supplementation. At the Center for Better Bones, we always recommend therapeutic doses of all the 20 key bone-building nutrients for optimum fracture healing. While no scientist has yet conducted a clinical trial using all 20 key nutrients for fracture healing, several studies have found multi-nutrient therapy to reduce complication and accelerate fracture healing. A 2006 Swedish hip fracture study found fracture patients given complex multi-nutrient supplementation containing protein, carbohydrates, amino acids, sodium, potassium, calcium, magnesium, chloride, trace minerals, and fat soluble vitamins, had only a 15% rate of complications as compared to a 70% complications rate among the non-supplemented group. Also impressive is a Swedish meta-analysis of 17 such clinical hip fracture trials which reported that oral multi-nutrient supplementation (including nutrients such as carbohydrates, protein, arginine, zinc, and antioxidants) reduced deaths and complications from hip fracture by nearly 50%.
Another innovative placebo controlled, multi-nutrient study from India administered vitamin C, lysine, praline, and vitamin B6 to tibial fracture patients. In those receiving multi-nutrient therapy, fracture healing time was reduced by approximately two weeks, with a larger percentage healing in 10 weeks (33%) as compared to the 11% in the placebo group.
An Alkaline for Life® eating program stimulates bone repair
The Alkaline for Life® eating program provides a diet rich in minerals, vitamins, and phytonutrients obtained from vegetables, fruits, nuts, and seeds. This life-supporting eating pattern has been shown to create a health-promoting internal biochemical environment which, among other things, conserves bone building minerals and proteins. Such a base-forming eating program also has been shown to increase growth hormones and growth factors such as IGF insulin-like growth factor. These growth hormones are among the most important biochemical forces encouraging fracture repair and new bone formation.
Herbal fracture healing aids
Throughout history, and even today in much of the world, traditional herbal medicine has been the mainstay of medical practice. This long tradition of herbal wisdom has employed various herbs to speed fracture healing. Among these is cultivated (European) comfrey (Sympathy uplandics x.), which should not be confused with a potentially toxic wild variety (Sympathy officinale), nor with a native herb that is also called “wild comfrey” (Colosseum virginianum) that is native to the US. Herbalist Susun Weed recommends cultivated comfrey be used as an aid in fracture healing. Details of her recommendation are available at . She also reports great success applying a hot, fresh burdock leaf poultice to reduce the swelling induced by a fracture. Arnica (Arnica Montana) is reportedly another helpful herb, as detailed by herbal researcher Alma Hutches, but it must be used with caution as large amounts are poisonous. She reports that five drops or fewer of Arnica tincture given every 3 to 4 hours after the initial trauma is said to help recovery from the trauma of fracture. Horsetail grass is an herb high in silicon, which can be boiled and made into a tea valuable in the early stages of fracture healing. In all cases, however, herbal medicine should be used under the guidance of a qualified herbalist.
Traditional Chinese herbal medicine can be an effective way to reduce the swelling, pain, and soreness of fracture. Chinese medicine can also accelerate healing when used under the guidance of an experienced practitioner. Finally, the traditional Ayurvedic medicine of India is now becoming known in the West and drawing the attention of scientists and pharmaceutical companies alike. The Indian herb Cissus quadrangular particular has been studied for its fracture-healing benefits.
As we look around the world, we would indeed expect to find traditional herbal approaches to fracture healing and those with access to an expert herbalist can benefit from this traditional wisdom.
Exercise and fracture healing
Exercise is unlikely to pop into your mind as an important way to accelerate fracture healing — yet it is. In general, bone tissue responds to patterns of loading by increasing matrix synthesis, altering composition, organization, and mechanical properties. Evidence indicates that the same holds true for bone under repair. Further, fracture healing requires good circulation and an adequate flow of nutrient-replenishing blood to the fracture site — both of which are enhanced by exercise. To avoid stress on the broken bone, joint loading, range of motion, and specific tendon-gliding exercises are employed to accelerate healing and assure return of function post fracture. For example, in the case of a broken forearm, exercises would involve movements of the fingers and hand, as well as the elbow and shoulder joints.
Energy medicine for fracture healing
Energy medicine is described in a recent medical journal as, “…a field of complementary therapy based on the interactions of the human energy field with other energy fields (human or other).” Interestingly enough, pulsing electromagnetic field therapy is a form of energy medicine that has been used for many years by conventional doctors to heal fractures that have not healed on their own (known as non-union fractures). Approximately 5 — 10% of bone fractures fail to heal normally and result in delayed healing or non-union. In these situations, the use of electromagnetic bone stimulating devices has proven to speed healing. For a review of the literature see:
Homeopathy, reiki, qi gong, polarity therapy, healing touch, acupuncture, and massage are all non-conventional energy healing modalities with applications for fracture healing. Common over-the-counter homeopathic remedies include arnica as an anti-trauma remedy for immediately after the fracture (not to be used if the person is unconscious), sympathy (comfrey) for pain relief and the joining of set bones, and Calcarea phosphoric a for fractures that are difficult to heal. Low-potency homeopathic remedies (6x, 6c to 30x, 30c) are often used for self-help, as detailed in Homeopathic Self-Care by Robert Pullman and Judyth Heisenberg-Pullman (Priam Publishing, 1997) and at WWW.peace health.org/base/cam/hn-2201007. Homeopathy is a powerful medicine and when possible the best policy is to seek the advice of a professional homeopath.
Acceptable alternatives to help reduce the pain of fracture include acetaminophen (as in Tylenol). In severe cases, narcotics such as codeine are given along with the acetaminophen. There are also natural pain-relief alternatives, including several nutrients that have been documented to help reduce the pain of inflammation of fracture while also enhancing the healing process. For example, in a study of 328 wrist fracture patients, modest 500 mg/day supplementation with vitamin C reduced by more than 4-fold the incidence of post-fracture complex regional pain syndrome. In clinical use at the Center for Better Bones, we have found that the well-studied flavonoid, quercitin, used in doses of 2–3 g per day, has a synergistic effect with vitamin C, amplifying the pain-relief benefits. These nutrients, as well as omega-3 fatty acids, reduce inflammation without inhibiting the COX-1 and COX-2 enzymes. In addition, European research has shown the value of proteolitic enzymes (protein digesting enzymes) such as bromelain and trypsin for reducing inflammation, edema, and pain in fracture patients. One such European proteolytic enzyme combination available in the US is the Wobenzym formula.
Numerous studies document that smoking delays the healing process and increases morbidity associated with fracture. For example, the fractured tibias of patients who smoked took 62% longer to heal than non-smokers. Further, postoperative complications such as delayed healing, infection, and fracture non-healing (non-union) are much more common among smokers.
A further example from a study at Johns Hopkins University found that:
- Current and previous smokers were less likely to achieve union than non-smokers.
- Current smokers were more than twice as likely to develop an infection.
- Previous smokers were 2.8 times more likely to develop osteomyelitis (bone infection).
Interestingly enough, the impact of smoking appears to be a non-nicotine effect involving delays in the cartilage-forming phase of fracture healing. All in all, the clear recommendation is that those who fracture cease smoking for the full rehabilitation period.
Alcohol in excess can be directly toxic to bone and alcohol abuse is associated with increases in both the incidence of fractures and complications of fracture healing, including infection. In a Danish ankle fracture study, for example, alcohol abusers had significantly more early complications, especially infections, from reparative ankle surgery. It is highly advisable to eliminate any excessive alcohol intake during fracture healing.
Bone is a complex, living tissue which constantly changes and adapts itself to the demands put upon it. A myriad of nutrients, hormones, and other biochemical factors are essential to bone formation and maintenance, so an equal number of factors figure in the bone repair process. While a fracture can be frightening and leave us questioning the strength of our skeleton, such a mishap might well be seen as a “window of opportunity” to make nutritional and lifestyle changes that will strengthen the entire skeleton and improve overall health.
I came to Dr. Brown through the internet, many months after having been hit by a car on my bike. My leg had been badly broken in several places, and a year later I still had a complete “nonunion” of the tibia and fibula. Better bones.com was the only nutritionally based service for supporting bone rebuilding that I could find and so I began consultations with Dr. Brown. With a solid footing in research evidence, she assessed my particular situation and guided me in adding specific bone-building supplements as well as making dietary adjustments and including complementary treatments. I recently had a surgical follow-up to my sixth round of orthopedic surgery, and at six months the bones are substantially healed. My surgeon was thrilled ( and surprised!), and of course I am ecstatic. ( I came pretty close to having my leg amputated) I have no doubt that Dr. brown’s work in the background helped with my phenomenal healing success. I should mention that I am 50 years old, and that long term unhealed bone injuries as well as ones that are distal (lower extremities) are notoriously hard to heal. Thank You, Dr. Brown!