Journal de Pharmacie Clinique


Synthetic bone subtitutes: what specificities? Volume 32, issue 2, Juin 2013

Service de pharmacie, AP-HP - Hôpital Antoine Béclère, Clamart, France, Service de chirurgie orthopédique, AP-HP - Hôpital Antoine Béclère, Clamart, France

Several surgical situations, e.g. orthopedic and dentistry, sometimes require a bone graft. Autologous bone grafting is the gold-standard treatment for bone reconstruction as it is the only that can provide osteoinductive growth factors, osteogenic cells and osteoconductive scaffold. However, this technique has some drawbacks such as donor site morbidity, increased operative time and providing insufficient quantity or quality. This explains the increasing use of synthetic bone graft substitutes as an alternative. After describing the main properties and characteristics of synthetic bone substitutes, we discuss their classification. They are principally divided into three main categories: calcium phosphate ceramics, calcium phosphate cements and bioactive glass. For products of the same chemical class, there are signifiant differences in porosity, mechanical strength or resorption time. In the literature, some relevant criterias were found to discriminate alternative products within the same class. Nevertheless, available data often lack of homogeneity (reference standard method for assessing the different products), making comparison very difficult. Indeed, studies on animals rarely use the same animal model and the nature and pace of data collection differ. Regarding clinical studies, they are infrequent and rarely randomized, so the evidence level associated with them is generally low. Although the uses of bone substitutes are guided by their properties, there is no consensus for selecting a synthetic bone substitute for an indication: the choice depends on the surgeon's practice.