TY - JOUR
T1 - Bioinorganic supplementation of calcium phosphate-based bone substitutes to improve in vivo performance
T2 - a systematic review and meta-analysis of animal studies
AU - Lodoso-Torrecilla, Irene
AU - Gunnewiek, Raquel Klein
AU - Grosfeld, Eline-Claire
AU - de Vries, Rob B. M.
AU - Habibovic, Pamela
AU - Jansen, John A.
AU - van den Beucken, Jeroen J. J. P.
N1 - Funding Information:
This work is financially supported by Life Science & Health (project BONE-IP2), Dutch Ministry of Economic Affairs. P. H. gratefully acknowledges the Gravitation Program “Materials Driven Regeneration”, funded by the Netherlands Organization for Scientific Research (024.003.013). The authors want to thank Alice H. J. Tillema for the help with the systematic search strategy development. I. L. T wants to thank Ms Bing Wang, DDS for her help in the translation from Chinese of three of the included papers.
Publisher Copyright:
© 2020 The Royal Society of Chemistry.
PY - 2020/9/7
Y1 - 2020/9/7
N2 - Supplementation of CaP-based bone graft substitutes with bioinorganics such as strontium, zinc or silicon is an interesting approach to increase the biological performance in terms of bone regenerative potential of calcium phosphate (CaP)-based bone substitutes. However, thein vivoefficacy of this approach has not been systematically analyzed, yet. Consequently, we performed a systematic review using the available literature regarding the effect of bioinorganic supplementation in CaP-based biomaterials on new bone formation and material degradation in preclinical animal bone defect models and studied this effect quantitatively by performing a meta-analysis. Additional subgroup analyses were used to study the effect of different bioinorganics, animal model, or phase category of CaP-based biomaterial on bone formation or material degradation. Results show that bioinorganic supplementation increases new bone formation (standardized mean difference [SMD]: 1.43 SD, confidence interval [CI]: 1.13-1.73). Additional subgroup analysis showed that strontium, magnesium and silica significantly enhanced bone formation, while zinc did not have any effect. This effect of bioinorganic supplementation on new bone formation was stronger for DCPD or beta-TCP and biphasic CaPs than for HA or alpha-TCP (p<0.001). In general, material degradation was slightly hindered by bioinorganic supplementation (mean difference [MD]: 0.84%, CI: 0.01-1.66), with the exception of strontium that significantly enhanced degradation. Overall, bioinorganic supplementation represents an effective approach to enhance the biological performance of CaP-based bone substitutes.
AB - Supplementation of CaP-based bone graft substitutes with bioinorganics such as strontium, zinc or silicon is an interesting approach to increase the biological performance in terms of bone regenerative potential of calcium phosphate (CaP)-based bone substitutes. However, thein vivoefficacy of this approach has not been systematically analyzed, yet. Consequently, we performed a systematic review using the available literature regarding the effect of bioinorganic supplementation in CaP-based biomaterials on new bone formation and material degradation in preclinical animal bone defect models and studied this effect quantitatively by performing a meta-analysis. Additional subgroup analyses were used to study the effect of different bioinorganics, animal model, or phase category of CaP-based biomaterial on bone formation or material degradation. Results show that bioinorganic supplementation increases new bone formation (standardized mean difference [SMD]: 1.43 SD, confidence interval [CI]: 1.13-1.73). Additional subgroup analysis showed that strontium, magnesium and silica significantly enhanced bone formation, while zinc did not have any effect. This effect of bioinorganic supplementation on new bone formation was stronger for DCPD or beta-TCP and biphasic CaPs than for HA or alpha-TCP (p<0.001). In general, material degradation was slightly hindered by bioinorganic supplementation (mean difference [MD]: 0.84%, CI: 0.01-1.66), with the exception of strontium that significantly enhanced degradation. Overall, bioinorganic supplementation represents an effective approach to enhance the biological performance of CaP-based bone substitutes.
KW - MAGNESIUM-ENRICHED HYDROXYAPATITE
KW - SINUS FLOOR ELEVATION
KW - IN-VIVO EVALUATION
KW - STRONTIUM RANELATE
KW - CALVARIAL DEFECT
KW - GENE-EXPRESSION
KW - POLYPHOSPHATE SCAFFOLDS
KW - DICALCIUM SILICATE
KW - ZINC
KW - CEMENT
U2 - 10.1039/d0bm00599a
DO - 10.1039/d0bm00599a
M3 - (Systematic) Review article
C2 - 32729591
SN - 2047-4830
VL - 8
SP - 4792
EP - 4809
JO - Biomaterials Science
JF - Biomaterials Science
IS - 17
ER -