Research brief · 2026-09-09
What Actually Speeds Up Fracture Healing?
Fracture healing runs on its own biological timeline, and remarkably few interventions have been shown to shorten it. The evidence is clearer about what gets in the way than about what helps.
The most-tested accelerant is low-intensity pulsed ultrasound. Searle's 2023 Cochrane review pooled 21 randomized trials covering 1,543 fractures. For delayed union or nonunion at up to 12 months, there was moderate-certainty evidence of little or no difference from control. Time to union could not be pooled because the trials reporting it disagreed too widely, and every included trial carried unclear or high risk of bias.
Two other candidates fell short. Teriparatide, a prescription bone-building drug for osteoporosis, raised bone mineral density significantly across eight trials and 744 hip fracture patients in Luo's 2024 meta-analysis, but the fracture healing rate did not differ from control. Heyer's 2021 randomized trial in the Journal of Bone and Mineral Research gave 32 postmenopausal women with wrist fractures a low or high vitamin D bolus or nothing. The high-dose group showed lower trabecular bone number and lower compression stiffness than controls, a signal of harm rather than help.
The stronger signals point the other way. Smolle's 2021 meta-analysis in EFORT Open Reviews pooled 69 studies and found smokers had a relative risk of 1.85 for nonunion after fracture surgery and more than double the infection risk. Kim's 2021 propensity-matched study of 8,693 fracture surgery patients found NSAID use for three weeks or less was not linked to nonunion, while use beyond three weeks was associated with significantly higher nonunion and delayed union.
The limits are notable. The ultrasound trials could not identify any subgroup that benefits, the vitamin D trials did not study truly deficient people, and no study followed smokers who quit after a fracture. Questions about pain medication or supplements during fracture recovery belong with the treating physician.
Sources
- Searle HKC et al. Ultrasound and shockwave therapy for acute fractures in adults
- Cochrane Database of Systematic Reviews 2023
- Smolle MA et al. Fracture, nonunion and postoperative infection risk in the smoking orthopaedic patient: a systematic review and meta-analysis
- EFORT Open Reviews 2021
- Kim H et al. Do NSAIDs or COX-2 Inhibitors Increase Nonunion or Delayed Union Rates After Fracture Surgery? A Propensity-Score-Matched Study
- Journal of Bone and Joint Surgery 2021
- Heyer FL et al. The Effect of Bolus Vitamin D Supplementation on Distal Radius Fracture Healing: A Randomized Controlled Trial Using HR-pQCT
- Journal of Bone and Mineral Research 2021
Peptide Proof reports what studies found. We do not give medical advice, dosing guidance, or treatment recommendations.