Diabetes Mellitus and Bone Regeneration: A Systematic Review and Meta-Analysis of Animal Studies

Camargo, Winston A.; Vries, Rob de; Luijk, Judith van; Hoekstra, J.A.; Bronkhorst, Ewald M.; Jansen, John A.; Beucken, Jeroen J.J.P. van den

doi:10.1089/ten.teb.2016.0370

Cited by 37 publications

(29 citation statements)

References 57 publications

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“…Moreover, our study included a three to five times larger proportion of patients with diabetes than other studies (Table ). Diabetes was associated with a very poor prospect of healing in our study, and accumulated evidence from animal studies suggests that bone regeneration is strongly reduced in animals with diabetes . Taken together, these differences probably explain why the overall healing rate in our study was lower than others’.…”

Section: Discussioncontrasting

confidence: 59%

Predictors of fracture healing in patients with recalcitrant nonunions treated with autologous culture expanded bone marrow‐derived mesenchymal stromal cells

Bhattacharjee

Kuiper

Roberts

et al. 2019

Journal Orthopaedic Research

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The study reports the prospective outcome of treating severe recalcitrant fracture nonunion in patients with autologous bone marrow‐derived mesenchymal stromal cells (BMSC) from 2003 to 2010 and analyze predictors of union. Autologous BMSC were culture expanded and inserted at nonunion site with or without carriers in addition to surgical stabilization of the fracture. Radiological union was ascertained by musculoskeletal radiologists on plain radiographs and/or CT scans. A logistic regression analysis was performed with cell‐expansion parameters (cell numbers, cell doubling time) and known clinical factors (e.g., smoking and diabetes) as independent variables and fracture union as the dependent variable to identify the factors that influence bony healing. An Eq5D index score assessed the effect of treatment on general quality of health. A total of 35 patients (mean age 51+/−13 years) with established nonunion (median 2.9 years, 1–33) and, at least one failed nonunion surgery (median 4,1–14) received treatment. Fracture union was achieved in 21 patients (60%; 95%CI 44–75) at 2.6 years. Multiple penalized logistic regression revealed faster cell doubling time ( p = 0.07), absence of diabetes ( p = 0.003), less previous surgeries ( p = 0.008), and lower age at cell implantation ( p = 0.02) were significant predictors for fracture union. A significant increase in Eq5D index ( p = 0.01) was noted with a mean rise of the score by 0.34 units (95%CI 0.11–0.58) at 1 year following the study. In summary, the study revealed cell doubling time as a novel in vitro parameter in conjunction with age, multiple surgeries, and diabetes as being significant predictors of the fracture union. © 2018 The Authors. Journal of Orthopaedic Research ® Published by Wiley Periodicals, Inc. J Orthop Res 37:1303–1309, 2019.

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Section: Discussioncontrasting

confidence: 59%

Predictors of fracture healing in patients with recalcitrant nonunions treated with autologous culture expanded bone marrow‐derived mesenchymal stromal cells

Bhattacharjee

Kuiper

Roberts

et al. 2019

Journal Orthopaedic Research

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“…In our review process it has been identified some studies evaluating the success of bone regeneration techniques in DM animals (22–30), however, there were few regarding DM in humans despite the safety of performing implant therapy in such condition having been proven. Studies in non-controlled DM patients are even scarcer, probably due to the previously mentioned complications and ethical reasons.…”

Section: Discussionmentioning

confidence: 99%

Bone regeneration in diabetic patients. A systematic review

2019

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Background Oral bone regeneration techniques (OBRT) attempt to provide the appropriate bone volume and density to correctly accomplish dental implant treatments. The objective was to determine whether differences exist in the clinical outcomes of these techniques between diabetic and non-diabetic patients, considering the level of scientific evidence. Material and Methods A systematic review following PRISMA statements was conducted in the PubMed, Scopus and Cochrane databases with the search terms: “Diabetes Mellitus”, “guided bone regeneration”, “bone regeneration”, “alveolar ridge augmentation”, “ridge augmentation”, bone graft*, “sinus floor augmentation”, “sinus floor elevation”, “sinus lift”, implant*. Articles were limited to those published less than 10 years ago and in English. Inclusion criteria were: human studies of all bone regeneration techniques, including at least 10 patients and the using OBRT in diabetic and non-diabetic patients. Non-human studies were excluded. They were stratified according to their level of scientific evidence related to SORT criteria (Strength of Recommendation Taxonomy). Results The initial search provided 131 articles, after reading the abstracts a total of 33 relevant articles were selected to read the full text and analyzed to decide eligibility. Finally, seven of them accomplished the inclusion criteria: two controlled clinical trials, one cohort study and four case series. Conclusions A low grade of evidence regarding the use of OBRT in diabetic patients was found. The recommendation for this intervention in diabetic patients is considered type C due to the high heterogeneity of the type of diabetic patients included and the variability of the techniques applied. Key words: Diabetes Mellitus, guided bone regeneration, bone regeneration.

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“…Ideally, all experiments should be performed in a similar manner, but as previously observed in other systematic reviews using pre-clinical studies, this is difficult to achieve. 3,158,159 Another limitation of the systematic review is the low quality of reporting in pre-clinical papers. Study blinding was seldom reported and randomization was reported in less than half of the included papers.…”

Section: Limitations Of the Study And Clinical Relevancementioning

confidence: 99%

“…Bone is one of the most commonly transplanted tissues with over 2 million bone graft procedures performed annually worldwide. 1 However, bone regeneration is still a challenge for large defects or in patients with systemic diseases that negatively affect bone regeneration (e.g., osteoporosis 2 or diabetes mellitus 3 ). Autografts, i.e.…”

Section: Introductionmentioning

confidence: 99%

Bioinorganic supplementation of calcium phosphate-based bone substitutes to improvein vivoperformance: a systematic review and meta-analysis of animal studies

Lodoso‐Torrecilla

Gunnewiek²,

Grosfeld

et al. 2020

Biomater. Sci.

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Diabetes Mellitus and Bone Regeneration: A Systematic Review and Meta-Analysis of Animal Studies

Abstract: These findings prove that DM type 1 negatively influences bone formation compared with a healthy condition, irrespective of the bone substitute material used.

Cited by 37 publications

References 57 publications

Predictors of fracture healing in patients with recalcitrant nonunions treated with autologous culture expanded bone marrow‐derived mesenchymal stromal cells

Predictors of fracture healing in patients with recalcitrant nonunions treated with autologous culture expanded bone marrow‐derived mesenchymal stromal cells

Bone regeneration in diabetic patients. A systematic review

Bioinorganic supplementation of calcium phosphate-based bone substitutes to improvein vivoperformance: a systematic review and meta-analysis of animal studies

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