Athletes may potentially benefit from pharmaceutical agents that prevent stress fractures or speed the healing process of acute and stress fractures. The value of such medications will depend on how quickly the athlete returns to competition in relation to the financial costs and possible negative side effects. As discussed, there is currently no clear evidence that any of the discussed agents either facilitate or impede human fracture healing.
The recent discoveries of several bone-forming growth factors will ensure that research continues in this field. Bone morphogenic proteins, fibroblast growth factors, transforming growth factor-13, and other growth factors may eventually play a pivotal role in both fracture prevention and treatment. Interestingly, insulin-like growth factor (IGF)-I may interact significantly with PTH as a mediator of bone formation, in part by secreting IGF-I binding proteins in osteoblast-like cells .
The efficacy of any pharmaceutical agents will be determined only through large, randomized clinical trials. Although disease-oriented outcome measures such as bone mass density and callous size have been used in previous trials, future research must focus on patient-oriented outcomes such as time to return to full activity and decreased pain. The trials should consist of multicenter efforts, enrolling a large number of individuals participating in a variety of sports to allow for a representative number of different fractures. Without such highlevel evidence, any definitive comment on the positive or negative effects of PTH, bisphosphonates, or NSAIDs is purely speculative.
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