With an aging population worldwide, the frequency of osteoporotic fractures is increasing. Therefore, biological methods to enhance the internal fixation of osteoporotic fractures becomes more important to reduce the societal burden of care. The purposes of this study were to evaluate the role of platelet-rich plasma (PRP) in the treatment of osteoporotic fractures and to clarify the best concentration of PRP. Bone marrow mesenchymal stem cells isolated from osteoporotic rats were cultured in high- (8.21±0.4×10(9)/mL), medium-(2.65±0.2×10(9)/mL), and low-concentration (0.85±0.16×10(9)/mL) PRP and in platelet-poor plasma (8±0.5×10(6) platelet/mL). The capacities of cell proliferation and osteogenic and adipogenic differentiation were compared. A transverse osteotomy was performed in the middle of the left femoral diaphysis followed by K-wire fixation, and various concentrations of PRP were transplanted into the fracture zone. Radiologic, mechanical, and histologic evaluations were performed at 2, 4, and 8 weeks, respectively. The results indicated that PRP could inhibit adipogenic differentiation and that medium-concentration PRP was effective in inducing the proliferation and osteogenic differentiation of bone marrow mesenchymal stem cells derived from osteoporotic bone marrow and in promoting fracture healing, whereas high-concentration PRP inhibited osteogenic differentiation and callus remodeling. Certain concentrations of PRP can effectively enhance the healing of osteoporotic fractures. Medium-concentration PRP is a suitable concentration to use in practice.
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