Purpose: To fill this gap considering the incorporation of gallium into bone tissue, mechanisms of therapeutic activity of this element, as well as the formation, growth and solubility of hydroxyapatite in the presence of gallium salts. Justification: In contrast to other calcium-saving drugs, salts of trace element gallium are effective in severe hypercalcemias. Gallium (most commonly in the form of its nitrate) enhances calcium and phosphorus content of the bone and has direct, non-cytotoxic effects on osteoclasts at markedly low doses. Although the details of gallium action on the bone are still uncertain, it is well established that the mechanism involves gallium insertion into the hydroxyapatite matrix protecting it from resorption and improving biomechanical properties of the skeletal system. The drug also acts on the cellular components of bone to reduce bone resorption by decreasing acid secretion by osteoclasts. Much has been published about the use of gallium in managing a series of clinical conditions in which this pathology is pronounced. Conclusions: Due to its interesting and promising profile gallium merits further experimental and clinical evaluation as an antiresorptive agent in orthopaedics, traumatology and cancer-related conditions. Greater knowledge of the mechanisms involved may provide insights for therapeutic strategies aimed at diminishing hypercalcemia and bone loss. New gallium compounds are expected to be developed and tested clinically.Keywords: Gallium, Hypercalcemia, Hydroxyapatite, Bone resorption, Bone metabolism.
INTRODUCTIONIt is estimated that more than 200,000 spine fusion procedures are performed each year in the United States. Posterolateral lumbar intertransverse process arthrodesis is the most common procedure performed, yet failure to achieve a solid bony union occurs in 10% to 40% of patients with only single-level fusions, and more frequently when multiple levels are attempted. This high rate of nonunion indicates that the physiological, biological and chemical events crucial to this process are not adequately understood. A nonunion frequently leads to unsatisfactory resolution of clinical symptoms and usually results in greater medical costs and morbidity, as well as the need for additional surgeries (1) . Unfortunately, the effect of metal ions on the mineralization process has not received considerable attention until recently, although interesting data on aluminum and gallium participation in bone metabolism had been published more than 15 years ago (2) . At present, the number of publications dedicated to the role of gallium in bone pathology is growing rapidly but no comprehensive reviews are available. The aim of the present work is to fill this gap considering the formation, growth and solubility of hydroxyapatite in the presence of gallium salts, the incorporation of gallium into bone tissue and mechanisms of therapeutic activity of this element.
Gallium propertiesGallium is a trace metallic element that is liquid near room temperature, expands on soli...