BoneKEy Reports | BoneKEy Watch

Allograft plus BMP-7 plus bisphosphonate is superior to autograft for non-union fractures

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DOI:10.1038/bonekey.2013.196

Patients with a fracture that fails to achieve union are usually treated using an autograft, but harvesting causes significant problems at the donor site and the amount of bone retrieved is often limited. Here researchers compared an autograft alone with a bone allograft combined with locally applied bone morphogenetic protein (BMP-7) and systemic zoledronate.

Seven groups of rats (n=12) were given one of seven treatment regimes following a femoral osteotomy with intramedullary fixing. Autografts or allografts (obtained from donor rats and frozen) were applied around the circumference of the osteotomy site, with and without a putty containing BMP-7, bovine collagen and carboxymethylcellulose. A systemic dose of zoledronate was given to some of the groups two weeks later, while controls received saline only. Analysis of the level of healing was carried out six weeks after the initial osteostomy.

Rats given an allograft, BMP-7 and zoledronate showed the highest quality of callus, with a larger volume, denser structure and superior mechanical qualities.

Editor’s comment: This rodent open fracture model showed that a high incidence of non-union was not favorably modulated by treatment with allograft. Adding BMP-7 to the allograft increased osteoinduction to achieve union, while also adding a bisphosphonate further increased bone volume and strength. This adds to the evidence that biologic manipulation of anabolism and catabolism may improve outcomes in patients with difficult fractures.

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