Initial treatment of Jones fractures is still controversial, the essential choice being between operative and nonsurgical management. Although surgical intervention for certain proximal fifth metatarsal fractures may speed up recovery time, most fractures heal with immobilization. The vascular anatomy of the fifth metatarsal plays a role in the difficult healing of this fracture because the injury location corresponds to the site where the nutrient vessels enter the medial cortex, possibly rendering it avascular. Immunosuppressive therapy using glucocorticoids seems to be the main cause of osteoporosis after renal transplantation. Renal transplant patients exhibit increased rates of trabecular bone fractures, probably due to glucocorticoid-induced osteopenia.
Glucocorticoids exert both direct and indirect effects on bone.
The direct effects include inhibiting bone formation and enhancing bone resorption. The indirect effects include decreasing intestinal calcium absorption and increasing renal excretion, among others. The lowest mean BMD values were measured 6 to 24 months posttransplantation. The use of drugs such as cyclosporin A or azathioprine, as well as metabolic causes such as parathyroid hormone level and graft function, fails to show significant additional differences before and after the second posttransplant year. In refractory cases, the use of calcitonin, bisphosphonates, sodium fluoride, or estrogen replacement should be considered.