BMP-7 Versus BMP-2 for the Treatment of Long Bone Nonunion

Abstract

The authors compared the results of treating nonunion with either bone morphogenetic protein (BMP)-7 or BMP-2. Between 2001 and 2009, 214 limb segments were treated for nonunion with either BMP-7 or BMP-2 at the authors' institution. Sixty-three subjects received 76 units of BMP-7. Radiographic healing occurred in 70% of limb segments at an average of 30 weeks after surgery, and 75% of limb segments were weight bearing at an average of 23 weeks after surgery. In 15.8%, persistent nonunion necessitated additional surgery. Average follow-up was 32 months. One hundred twelve subjects received 138 units of BMP-2. Radiographic healing occurred in 93% of limb segments at an average of 19 weeks after surgery, and 88% were weight bearing at an average of 15 weeks after surgery. In 6.25%, persistent nonunion necessitated additional surgery. Average follow-up was 17 months. Several significant differences were observed. Patients in both BMP-7 and BMP-2 groups were able to fully weight bear at an average of 23 and 15 weeks, respectively (P<.001). Further, both BMP-7 and BMP-2 groups healed at an average of 30 and 19 weeks, respectively (P<.001). Additionally, healing occurred in more limb segments in the BMP-2 group (93%) than in the BMP-7 group (70%) (P<.001). No difference in the complication rate was seen between groups. Patients who received BMP-2 for the treatment of nonunion had a higher rate of radiographic healing, achieved radiographic healing more quickly, and were able to bear weight sooner than those who underwent treatment with BMP-7.

Recombinant Human Bone Morphogenetic Protein-2 (rhBMP-2) for the Treatment of Nonunion of the Femur in Children and Adolescents: A Retrospective Analysis

“…Only one of these femoral nonunions healed after initial rhBMP-7 application; one healed after additional surgery with iliac crest bone grafting [24]. For the treatment of long bone nonunions, better results regarding the rate of union and the time to union have been reported for rhBMP-2 compared to rhBMP-7 use in a recently published study [25]. …”

Clinical application of bone morphogenetic proteins for bone healing: a systematic review

“…In general, while there is a tendency to use rhBMPs for certain indications, there is no consensus about the best BMPs for the regeneration of each specific bone pathology and the only comparison was performed by Conway et al [56] in a retrospective study, with a higher and faster rate of radiographic bone non-union healing with rhBMP-2 compared to rhBMP-7, and no difference in the complication rate between groups. However, the overall lack of well-designed comparative studies prevents determining if both BMPs are equally effective or if they differ in terms of enhancement potential of bone healing in heterogeneous orthopaedic conditions.…”

“…On the other hand, this literature research also revealed that most of the clinical findings are based on case reports or case series with small patient populations, characterized by different delivery approaches, anatomical locations, bone pathologies and dosages, which makes it difficult to draw any final conclusion about the real potential of BMPs therapy and the best protocol they can be applied to [43][44][45][46][47][48][49][50][51][52][53][54][55][56][57][58][59]. Therefore, further research in this direction is needed.…”

Improving Bone Regeneration Using Chordin siRNA Delivered by pH-Responsive and Non-Toxic Polyspermine Imidazole-4,5-Imine

“…Bone nonunion is a serious problem that may occur following bone fractures and segmental defects, resulting in a heavy financial burden for both the patient and for the government due to health care costs and the reduced ability of the patient to work [1,2]. Approximately 5% to 10% of fractures result in bone nonunion.…”

“…Approximately 5% to 10% of fractures result in bone nonunion. An improved understanding of bone biology could facilitate the treatment of bone nonunion [1]. Upon bone damage, bone mesenchymal stem cells (BMSCs) migrate to the damaged portion of bone and differentiate into osteoblasts, which secrete large amounts of extracellular matrix (ECM) to promote bone fracture healing.…”