Osteoporosis is a systemic skeletal disease. It is characterized by a disbalance of bone formation and bone resorption. It is treated by escalating steps of drug therapy. This is influencing bone density. However, therapies for fractures in osteoporotic patients are typically surgical without really treating the osteoporotic phenotype locally. Several possibilities exist. Some drugs used for systemic therapy can be administered locally to the defect space using drug delivery systems. Other local therapies have been applied to fracture and nonunion treatments. An important asset are stem cells that can be obtained from the bone marrow or adipose tissue. A more complete form including natural extracellular matrix and supporting cells is constituted by Reamer Irrigator Aspirator (RIA). Finally, an innovative possibility is taking molecular biology techniques into consideration. Osteoporotic fractures have a specific microRNA signature. These upregulated microRNAs can be counteracted by antagomirs. Using them, a broad range of effector messenger RNAs and thus proteins can be modulated. In summary, treatment of osteoporotic fractures should take more the osteoporotic pathogenetic pathways into consideration for locally treating and accelerating fracture healing
