Osteoinductive Potential of Commercial Demineralized Bone Matrix Products
October 1, 2017 | Special HTA Reports
Demineralized bone matrix (DBM) is well-established osteoinductive bone allograft material derived from pulverized cortical bone specimens. Osteoinduction refers to the induction of osteoblast formation from the patient's own osteogenic stem cells already present at the repair site. DBM osteoinductive properties are attributable to DBM's composition and claimed mechanisms of action. Often included with DBM and carrier material are growth factors that facilitate osteoinduction. Growth factors include bone morphogenetic proteins (BMPs), of which there are 14 known types (BMP-2 through BMP-15); vascular endothelial growth factor; fibroblast growth factor; platelet-derived growth factor; transforming growth factor beta; and insulin-like growth factor. Osteoconductive materials provide a three-dimensional substance into which capillaries, osteogenic cells, and other tissue can migrate and produce new bone. For additional information, see the articles by Campana et al. and Roberts and Rosenbaum.
DBM is processed from human bone tissue using a demineralizing agent, such as hydrochloric acid. Acellular particles are then added to a substrate, such as glycerol or a polymer, resulting in osteoinductive and osteoconductive bone graft material. The bone's mineral content is reduced to <5% of original levels. The remaining substance is 90% type I collagen and 10% noncollagenous protein containing a variety of bone growth stimulators (osteoinductive agents, such as BMPs). DBM is commonly used as a bone-graft extender for posterolateral spinal fusion surgery for which it is mixed with autologous bone. Numerous DBM products are commercially available for use in spinal surgery and other orthopedic procedures, each with different amounts of osteoinductive proteins. They may be combined with other materials to form the final product. Differences in preparation method, storage, and donor specifications among DBM products are responsible for the differences in osteoinductive potential. For additional information, see the...