Healing & Recovery
What Actually Speeds Up Fracture Healing?
The short answer
Less than commonly assumed. A 2023 Cochrane review of ultrasound and shockwave therapy — the most heavily studied 'accelerant' — found moderate-certainty evidence of little or no difference in nonunion risk across 1,543 fractures, and very-low-certainty, inconsistent effects on time to union. A randomized trial of high-dose vitamin D in postmenopausal women with wrist fractures found no healing benefit and a signal of worse bone stiffness at the higher dose. Teriparatide built more bone density in osteoporotic hip fracture patients across 8 pooled trials but did not speed up the fracture healing rate itself. The clearer findings run the other direction: smoking nearly doubled nonunion risk across 69 pooled studies, and NSAIDs taken at higher doses for longer than a couple of weeks were linked to more impaired healing in adults, though not in children or with short courses.
Quick answers
- What is it?
- This looks at which treatments — ultrasound devices, bone-building drugs, vitamin D, or avoiding certain habits — actually make a broken bone heal faster.
- Why are people interested in it?
- Anyone recovering from a fracture wants to know if there's anything they can safely do to speed up healing, beyond just waiting.
- What has actually been studied?
- A 2023 Cochrane review of ultrasound/shockwave therapy (21 trials, 1,543 fractures), a meta-analysis of teriparatide in osteoporotic hip fractures, randomized trials of vitamin D supplementation, and pooled data on smoking and NSAID use around fracture surgery.
- How strong is the evidence?
- Surprisingly weak for most "accelerants": the most-studied intervention (ultrasound) showed little or no difference in nonunion risk, vitamin D showed no benefit and a signal of harm at high dose, and teriparatide built bone density without speeding the fracture healing rate itself.
- What don't we know yet?
- Whether ultrasound helps any specific fracture subgroup, what vitamin D dose helps people who are genuinely deficient, whether teriparatide's benefits translate to fewer long-term complications, and whether quitting smoking after a fracture recovers any lost healing capacity.
- Where can I read the original research?
- Sources at the bottom of this page: Searle HKC, Lewis SR, Coyle C, et al., Cochrane Database of Systematic Reviews, 2023; and Smolle MA, Leitner L, Böhler N, et al., EFORT Open Reviews, 2021.
The short answer: Fracture healing runs on its own biological timeline, and remarkably few interventions have been shown to shorten it. The most heavily studied candidate — low-intensity pulsed ultrasound — failed to clearly beat placebo in the largest available review. A randomized trial of high-dose vitamin D found no benefit and a signal of harm. Teriparatide, a bone-building drug, raised bone density without speeding up the fracture healing rate itself. What the evidence supports more clearly are the things that get in the way: smoking and prolonged, higher-dose NSAID use.
What the research shows
The most-tested "accelerant" hasn't clearly accelerated anything
Low-intensity pulsed ultrasound (LIPUS) is the single most studied intervention aimed at speeding fracture healing, and a 2023 Cochrane review pooled the available randomized evidence: 21 trials, 1,543 fractures in 1,517 participants, 20 of them testing LIPUS and one testing extracorporeal shockwave therapy (ECSW). The results were unimpressive. For delayed or nonunion at up to 12 months, the review found moderate-certainty evidence of little or no difference between LIPUS and control (relative risk 1.25, 95% CI 0.50–3.09, across 7 studies and 746 participants). Time to fracture union couldn't even be pooled because the 11 studies reporting it disagreed too much to combine — in upper-limb fractures, LIPUS was linked to anywhere from 40 fewer days to a third of a day fewer; in lower-limb fractures, effects ranged from 88 fewer days to 30 more days, all rated very-low certainty. Health-related quality of life a year out showed no meaningful difference (MD 0.06, 95% CI −3.85 to 3.97), and time to return to work was, if anything, slightly worse with LIPUS (MD 1.96 days favoring control). The reviewers concluded LIPUS "probably" makes little or no difference to nonunion and called for better-blinded, placebo-controlled trials — the existing evidence base has unclear or high risk of bias in every included study.
A bone-building drug that didn't build faster fractures
Teriparatide, a form of parathyroid hormone used to treat osteoporosis, has been proposed as a way to speed fracture repair since it clearly stimulates bone formation. A 2024 meta-analysis pooled 8 randomized trials and 744 patients with osteoporotic hip fractures (372 teriparatide, 372 control). Bone mineral density was significantly higher with teriparatide (p<0.001) — but the fracture healing rate itself was not significantly different between groups (p=0.82). Mortality, adverse events, deformity, and complication rates also showed no significant difference. The drug did significantly reduce subsequent fracture rates and improve pain and mobility scores. In short: teriparatide appears to make bone stronger and may lower the odds of a second fracture, but the data did not support it making a given fracture heal any faster.
Vitamin D: no clear benefit, and a hint of harm at higher doses
Vitamin D is routinely recommended for bone health, so it's a natural candidate to test directly against fracture healing. A randomized trial in 32 postmenopausal women with a distal radius (wrist) fracture compared a low-dose vitamin D bolus (equivalent to 700 IU/day, n=10), a high-dose bolus (equivalent to 1,800 IU/day, n=11), and no supplementation (n=11), tracking bone microarchitecture with high-resolution imaging over 12 weeks. Compared with no supplementation, the high-dose group showed a decrease in trabecular bone number (p<0.01), lower compression stiffness (p<0.05), and a rise in a bone-resorption marker, CTX (p<0.05). The low-dose group showed no significant difference from control. Notably, only 33% of participants had baseline vitamin D under 50 nmol/L — most weren't clearly deficient to begin with. Separately, the FAITH-2 pilot trial randomized 86 younger femoral neck fracture patients (mean age 41) to vitamin D3 4,000 IU/day or placebo for 6 months and found no significant difference in a composite of healing complications (hazard ratio 0.96, 95% CI 0.42–2.18, p=0.92) — though as a pilot it wasn't powered to detect a real effect either way.
What clearly gets in the way: smoking and prolonged NSAID use
The strongest signals in this literature aren't about accelerants — they're about things that measurably slow healing down. A 2021 systematic review and meta-analysis pooling 69 studies found smokers had a significantly higher relative risk of nonunion after orthopedic surgery generally (RR 2.15) and after fracture surgery specifically (RR 1.85), plus more than double the risk of postoperative infection (RR 2.20) and more than triple the risk of persistent nonunion after scaphoid nonunion surgery (RR 3.52).
NSAIDs show a more nuanced, dose-and-duration-dependent picture. A propensity-matched study of 8,693 fracture surgery patients found NSAID use for 3 weeks or less was not associated with higher nonunion risk — and was actually linked to a lower hazard of nonunion versus matched nonusers (HR 0.69, 95% CI 0.48–0.98) — but use beyond 3 weeks was associated with significantly higher nonunion and delayed union rates. A 2026 umbrella review reconstructing a meta-analysis from 38 primary studies confirmed the pattern: NSAID exposure was linked to higher nonunion risk overall (OR 1.56), the risk was concentrated in adults (OR 1.67) rather than children (OR 0.77, not significant), it rose with higher doses and longer courses, and it was not elevated with short-term use of 14 days or less.
What we don't know yet
Whether LIPUS helps any specific fracture subgroup. The Cochrane reviewers couldn't pool time-to-union data because of unexplained heterogeneity between trials — it's possible the device helps in some fracture types, ages, or comorbidity profiles and not others, but no retrieved study isolated that signal reliably.
What vitamin D dose, if any, helps people who are actually deficient. Both vitamin D trials retrieved here studied populations that were only mildly deficient at best. Neither answers whether correcting a true, severe deficiency changes healing outcomes.
Whether teriparatide's density and pain benefits translate to fewer long-term complications. The meta-analysis found no significant difference in healing rate, but did find fewer subsequent fractures — it's unclear whether that reflects a genuine bone-quality effect or is explained by something else in the pooled trials.
What actually explains NSAID's duration-dependent effect. The propensity-matched and umbrella-review data agree that short courses look safe and long courses look riskier, but neither identifies the underlying mechanism or a clear cutoff beyond "more than roughly two to three weeks."
Whether quitting smoking after a fracture recovers any of the lost healing capacity. The smoking data described here is about smokers versus nonsmokers at time of injury — none of the retrieved studies followed people who quit after a fracture to see whether their nonunion risk normalized.
Sources
- Searle HKC, Lewis SR, Coyle C, Welch M, Griffin XL. Ultrasound and shockwave therapy for acute fractures in adults. Cochrane Database of Systematic Reviews, 2023;3(3):CD008579. DOI
- Smolle MA, Leitner L, Böhler N, Seibert FJ, Glehr M, Leithner A. Fracture, nonunion and postoperative infection risk in the smoking orthopaedic patient: a systematic review and meta-analysis. EFORT Open Reviews, 2021;6(11):1006-1019. DOI
- Kim H, Kim DH, Kim DM, et al. Do Nonsteroidal Anti-Inflammatory or COX-2 Inhibitor Drugs Increase the Nonunion or Delayed Union Rates After Fracture Surgery? A Propensity-Score-Matched Study. Journal of Bone and Joint Surgery (American), 2021;103(15):1402-1410. DOI
- Komargodski R, Kittany S, Abu-Kishk I, Beeri Berkovitch R, Epstein D, Matok I. NSAID Use and Bone Healing: An Umbrella Review with a Reconstructed Meta-Analysis. Journal of the American Academy of Orthopaedic Surgeons, 2026. DOI
- Luo L, Lin J, Ma W, Fan J. Effectiveness of teriparatide in improving healing rates and bone-turnover markers of osteoporotic hip fracture: a meta-analysis. JPMA (Journal of the Pakistan Medical Association), 2024;74(4):741-751. DOI
- Heyer FL, de Jong JJA, Willems PC, 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;36(8):1492-1501. DOI
- Slobogean GP, Sprague S, Bzovsky S, et al. Fixation Using Alternative Implants for the Treatment of Hip Fractures (FAITH-2): The Clinical Outcomes of a Multicenter 2x2 Factorial Randomized Controlled Pilot Trial in Young Femoral Neck Fracture Patients. Journal of Orthopaedic Trauma, 2020;34(10):524-532. DOI
Article records maintained via PubMed. Peptide Proof reports what studies found. It does not provide medical advice, dosing guidance, or treatment recommendations.
Topic: Recovery & Tissue Research
Sources
- Ultrasound and shockwave therapy for acute fractures in adults
- Cochrane Database of Systematic Reviews, 2023 · n=1517 · DOI
- Fracture, nonunion and postoperative infection risk in the smoking orthopaedic patient: a systematic review and meta-analysis
- EFORT Open Reviews, 2021 · n=69 · DOI
- Do Nonsteroidal Anti-Inflammatory or COX-2 Inhibitor Drugs Increase the Nonunion or Delayed Union Rates After Fracture Surgery? A Propensity-Score-Matched Study
- Journal of Bone and Joint Surgery (American), 2021 · n=8693 · DOI
- NSAID Use and Bone Healing: An Umbrella Review with a Reconstructed Meta-Analysis
- Journal of the American Academy of Orthopaedic Surgeons, 2026 · n=38 · DOI
- Effectiveness of teriparatide in improving healing rates and bone-turnover markers of osteoporotic hip fracture: a meta-analysis
- JPMA (Journal of the Pakistan Medical Association), 2024 · n=744 · DOI
- 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 · n=32 · DOI
- Fixation Using Alternative Implants for the Treatment of Hip Fractures (FAITH-2): a Multicenter 2x2 Factorial Randomized Controlled Pilot Trial
- Journal of Orthopaedic Trauma, 2020 · n=86 · DOI
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