Bisphosphonate-loaded bone cement: Background, clinical indications and future perspectives

Area of Science:

• Biomaterials Science
• Orthopedic Surgery
• Pharmacology

Background:

• Bisphosphonates are effective against bone resorption and loss.
• Systemic bisphosphonate use has side effects.
• Bone cement is a viable drug delivery system in orthopedic surgery.

Purpose of the Study:

• To review alterations in bone cement properties when combined with bisphosphonates.
• To assess the local anti-osteoporotic and anti-tumor effects of bisphosphonate-loaded bone cement.

Main Methods:

• Systematic literature review of 51 retained papers after initial screening.
• Inclusion of 35 articles after abstract and full-text reading by two independent authors.
• Analysis of acrylic and calcium phosphate bone cements as carriers for bisphosphonates.

Main Results:

• Bisphosphonate incorporation, particularly nitrogen-containing ones like zoledronic acid, prolongs setting time and slightly reduces mechanical strength within acceptable limits.
• Local application of bisphosphonates in bone cement demonstrates potent anti-osteoclastic and osteogenic effects.
• A direct cytotoxic impact on neoplastic lesions was observed.

Conclusions:

• Bisphosphonate-loaded bone cement offers a promising local treatment for bone loss and cancer.
• Further research with specifically designed studies is needed to explore clinical applications and advantages.
• Optimizing drug quantity is crucial to maintain cement integrity and efficacy.