Bioinorganic supplementation of calcium phosphate-based bone substitutes to improve in vivo performance: a systematic review and meta-analysis of animal studies

Irene Lodoso-Torrecilla, Raquel Klein Gunnewiek, Eline-Claire Grosfeld, Rob B. M. de Vries, Pamela Habibovic, John A. Jansen, Jeroen J. J. P. van den Beucken*

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

4 Citations (Web of Science)

Abstract

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.

Original languageEnglish
Pages (from-to)4792-4809
Number of pages18
JournalBiomaterials Science
Volume8
Issue number17
DOIs
Publication statusPublished - 7 Sep 2020

Keywords

  • MAGNESIUM-ENRICHED HYDROXYAPATITE
  • SINUS FLOOR ELEVATION
  • IN-VIVO EVALUATION
  • STRONTIUM RANELATE
  • CALVARIAL DEFECT
  • GENE-EXPRESSION
  • POLYPHOSPHATE SCAFFOLDS
  • DICALCIUM SILICATE
  • ZINC
  • CEMENT

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