Bone fractures are common traumatic injuries that temporarily disable individuals from some daily activities. Fractures are seen as a break or discontinuity in the bone tissue. The types of bone fractures are:
Stress fractures: They are caused by excess pressure placed over the same spot over long periods of time.
Impact fractures: They occur when the blow inflicted on the bone puts a lot more stress over it that it can handle at once.
Pathological fractures: Certain diseases debilitate the bones to the extent that slightest sudden impacts can make them susceptible to fractures.
Bone fractures are characterized by intense pain, swelling, bruising, deformity and inability to move. It is necessary to find ways by which the healing time and complications associated with fractures can be reduced. This will not only provide relief to patients but also reduce costs related to treatment. This article evaluates the use of the medicinal plant, Curcuma longa or turmeric in bone fracture healing.
Composition of Turmeric
Turmeric is popular in South Asian countries as a spice and as a herb. Its yellow colored rhizome consists of the following compounds:
- Curcuminoids- They are responsible for the yellow color of the rhizome.
- Volatile oil- It imparts the pungent aroma to the spice.
- Sugars, resins and proteins
- Curcumin which makes up 90% of curcuminoid content is mainly responsible for the medicinal properties of turmeric.
Role of Turmeric in Bone Healing – Can it Help?
Bones possess the property of regeneration and repair in response to injury and this process of redevelopment is similar to how bones were generated for the first time during the fetal stage of human life. Most fractures heal without formation of scar tissue and the new bone developed is not different from the injured bone in any aspect.
Bone healing involves the participation of many cell types, cell signaling pathways and factors which regulate the immune system.
To best understand how turmeric can help in bone healing, let us understand what role it can play in various stages on bone healing.
Turmeric & Bone healing phases
Although it is a continuous process, for the purpose of understanding the process completely we will split bone regeneration into phases and explore how turmeric would affect each of these phases.
1. Acute inflammatory phase
After fracture, first blood cells migrate to the tissues surrounding the site of injury. The blood vessels constrict to prevent blood loss. After a few hours a blood clot known as haematoma is formed. All the cells within the clot degenerate and die. Even the cells at the tips of the fractured bone are deprived of nutrition and they die.
This step is very vital because the presence of such quantities of necrotic material initiates an acute inflammatory response. This phase lasts for about 7 days from the day of injury. Immune cells migrate to the fracture site and secrete proteins that promote inflammation. A loose aggregate of cells called granulation tissue develops.
Cyclo-oxygenase 2 is an enzyme produced at the site of inflammation and plays an active role in the process. A study was conducted in mice to where their fractures were treated with painkillers. Painkillers are known to inhibit COX-2 and it was seen that fracture healing failed in mice treated with painkillers.
Research also shows that regular painkillers may initiate a set of reactions which ultimately lead to bone resorption and impede bone healing.
Therefore some health practitioners advise only a short term of painkiller usage as they could delay fracture healing. Painkillers are reported to have side effects like stomach ulcers, digestive disorders, kidney failure, increased clotting risk etc.
Turmeric is a natural anti-inflammatory agent. It is known to reduce inflammation by regulating the activity of various enzymes and proteins belonging to the immune system. Also turmeric is not reported to cause any side effects as caused by painkillers. Therefore turmeric is considered a viable natural alternative to painkillers for the treatment of inflammation.
Having said this it would be important to bring to one’s notice that inflammation is a vital part of fracture healing therefore consuming anything antagonistic to it should be done with great care.
Low doses of turmeric are advised in this phase and it is best to consult a health practitioner about the same. Turmeric,especially curcumin, acts as an immunomodulator-it regulates immune responses and this effect is subject to dose and duration.
This suggests that turmeric could help in controlling inflammation only to an extent that it could reduce pain and swelling without affecting bone repair. Also no study has reported that curcumin could lead to bone resorption like regular painkillers.
What does this mean?
Turmeric and curcumin are safer alternatives to regular painkillers prescribed for pain and swelling occurring in bone fracture. Unlike regular painkillers they do not cause side effects and don’t impede bone healing.
2. Reparative phase
In this phase, the stem cells recruited earlier now begin to differentiate into cells with specific functions. The cells closest to the fracture gap differentiate into chondroblasts and form hyaline cartilage. The cells further away from the gap develop into osteoblasts and form woven bone.
These tissues grow in size and unite to form fracture callus. Osteoblasts aid in the formation of blood vessels in this new tissue. The callus is now replaced with lamellar bone by osteoblasts after deposition of calcium hydroxyapatite crystals. This new lamellar bone is finally replaced with trabecular bone and most of the original strength is restored.
Osteoblasts perhaps are the most important players in this stage of bone healing. Curcumin obtained from turmeric is reported to have a positive effect on osteoblasts.
A study conducted in China proves that the stem cells recruited in bone repair are promoted by curcumin to differentiate into osteoblasts.This activity of curcumin is attributed to the fact that at low doses curcumin induces heme oxygenase 1 (HO-1) production in the stem cells. This enzyme is essential for a stem cell to grow into an osteoblast.
The results showed that curcumin could significantly enhance the osteoblastic differentiation of the stem cells by upregulation of HO-1.
What does this mean?
Curcumin’s ability to promote the growth of chondroblasts or bone forming cells aids in hastening the reparative phase of bone fracture.
3. Remodeling phase
This phase involves replacement of trabecular bone by compact bone. Osteoclasts first absorb the trabecular bone and then osteoblasts deposit compact bone. The new bone developed closely imitiates the original bone’s shape and strength. This process takes about 3-5 years to complete.
The remodeling process involves activation of many proteins and different pathways which lead to production of osteoclasts.
Bone remodeling is very similar to a process named bone turnover. Bone turnover is a constant process which occurs in our body and the bone tissue is renewed by this process.
Studies show that despite of inhibiting growth of osteoclasts, curcumin still balances the activity of both osteoblasts and osteoclasts and maintains the bone turnover process in diseases that cause bone loss.In other words curcumin supports formation of new bone tissue.
Also most of the research on curcumin’s activity on bone health, suggests that curcumin has bone protective effect.
What does this mean?
Research does show that curcumin inhibits the growth of osteoclasts or cells that absorb bone and these cells are vital in the remodeling phase. However this effect is dose dependant and possibly occurs at high doses.
Also curcumin despite of inhibiting the formation of osteoclasts does not prevent formation of new bone tissue.
Turmeric reduces risk of bone fractures in osteoporosis
As mentioned previously, sick or weak bones are also susceptible to fractures. Osteoporosis is the most common bone disease that leads to weakening of bones and increased risks of fracture. Bone is a living tissue which is constantly repaired in the body- old tissue is replaced with new tissue.
This process includes absorption of old tissue and deposition of new material. Osteoporosis occurs when there is increased reabsorption of old tissue and new bone is not developed. Apart from genetic inheritance being the main cause, osteoporosis is significantly seen in post-menopausal women.
A research study performed on ovariectomized rats investigated whether low or high doses of curcumin had a substantial effect on bone loss caused by osteoporosis. Low dose was 10mg/kg and high dose was 50mg/kg and these does was administered for 8 weeks. It was seen that only high dose could bring about significant increase in mechanical strength of the bone.
This effect of curcumin is brought about by its anti-inflammatory activity which inhibits the activities of signaling molecules which promote osteoclastgenesis. Reduced osteoclasts lead to reduced reabsorption of bone tissue thus preventing bone loss. Strengthening of bones reduces risk of fractures.
Other medicinal properties of turmeric that help in Bone healing
STAT1 belongs to the family of factors essential for cell growth, survival and differentiation. STAT1 protein is responsible for production of interferons- proteins produced in defense to pathogens.
A study conducted in fracture model in mice showed that the events involved in repair phase such as fracture callus remodeling and development of lamellar bone are accelerated.
Curcumin is proven to inhibit the phosphorylation (addition of phosphate group that can alter the activity of the protein) of STAT1 due to its anti-inflammatory property.
Curcumin can also help with pain occurring in bone fracture. (Read Turmeric for Various kinds of Pain). Turmeric has excellent wound healing properties. In fact traditionally turmeric paste is applied to fractured area before dressing it.
Traditional bone setting practice carried out in Puttur, Andhra Pradesh, India goes by the name of Puttur Kattu. This technique was invented in 1881. This practice involves diagnosis of exact fracture or dislocation followed by generally two sittings of bandage application. In the first sitting only the paste of the medicinal herb Cassia accidentalis is applied and a bandage is fixed with the help of bamboo sticks. This reduces pain and swelling. During the second sitting, the paste of the herb is applied in combination with a mixture of egg white and turmeric. This enhances bone healing by formation of bone callus and bone remodeling.
However it is important to know that this healing process is attributed to the skill of aligning the bones and not to the herbs. The herbs just act as catalysts to the healing process. Traditional bone setting requires training and though profound literature can be found in Ayurveda regarding this topic, even qualified Ayurvedic doctors are not able to practice bone setting.
Use of Turmeric in Bone Fractures
Ayurveda recommends topical application of turmeric paste in case of fractures, only when the bones are carefully aligned and bandaged with great precision. This can be done only by well experienced practitioners. Remedies which can be followed at home are:
- Consumption of turmeric milk is one of the age old remedies prescribed by traditional medicine. Consumption of turmeric milk on regular basis is known to improve immunity. Also calcium obtained from milk helps to strengthen bones and turmeric aids the system with the help of its anti-inflammatory, antioxidant and antimicrobial properties. Read the recipe for turmeric milk here
- In case of inflammation due to bone fractures, it is advisable to consume turmeric supplements over painkillers but within prescribed dose limits. Turmeric supplements are also proven remedial in case of diseases such as osteoporosis and rheumatoid arthritis which pose the risk of fractures.
Turmeric consumed as a culinary spice is reported to be safe.
The dosage mentioned below is the daily dose limit of turmeric and not doses prescribed for bone fracture healing.
- 400-600mg of standardized powder can be consumed 3 times a day.
- In case of fluid extract (1:1), a dose of 30-90 drops per day is prescribed.
- Tincture preparation (1:2) can be consumed at 15-30 drops 4 times a day
If opting for supplements, then this resource can help you find good brands.
For a detailed article on turmeric dose, read this article
Turmeric supplements are to be consumed with caution because overdose or interaction with other drugs can lead to complications. Few of the conditions where turmeric supplements should be avoided are:
- Allergy to turmeric
- Prior to surgical procedure
- Pregnancy and Lactation
- Gallstones and bile obstruction passages
Also it is important to note that inflammation is necessary for bone healing, so even if an individual chooses turmeric supplements as an analgesic over commercially available painkillers, the dose should be limited.
The skeletal and immune systems have a tightly woven interactive network. The skeletal system is home to the bone marrow- the reservoir of stem cells which further differentiate into a variety of cells including immune cells.
The immune system, apart from its defense to pathogens, is greatly involved in bone repair and healing. Therefore it is vital to study the molecular basis of this interaction so as to understand the state of skeletal structure during inflammation.
Most of the studies conducted on turmeric are in relation to treating bone cancer, osteoporosis and arthritis. It would be inappropriate to quote these studies in reference to bone fracture healing.
However many of them show that turmeric exerts bone protective effect. Also the dose of turmeric taken for healing bone fractures is much less than the concentration used in cell culture so it is not likely to cause any detrimental effect that would impede healing of bone fracture.
Lastly we should acknowledge curcumin is a pleiotropic molecule- it has multiple pharmacological responses depending upon dose and duration. Turmeric Milk is the best remedy for hastening repair of bone fractures.