Osteoinduction by demineralised bone

Bone contains several growth factors, including bone morphogenetic proteins (BMPs), transforming growth factor beta (TGF-beta), insulin-like growth factors I and II (IGF-I and IGF-II), platelet derived growth factor (PDGF) and basic and acidic fibroblast growth factor (bFGF and aFGF). The BMPs are the only factors known to provoke bone formation heterotopically by making undifferentiated mesenchymal cells differentiate into osteoblasts (osteoinduction). Much of our knowledge of osteoinduction derives from studies in rodents of heterotopically implanted demineralised bone which contains various growth factors, including BMPs. This model has been used to examine the effect on osteoinduction of different factors, including the type of host soft tissue, age and species of donor and recipient, demineralisation procedure, storage and sterilisation procedures, experimental diabetes, dietary factors, hormones, growth factors, caffeine, biphosphonates, indomethacin and biomaterials. Demineralised bone enhances bone formation experimentally in various animal models, including cranio-maxillofacial reconstructions, healing of diaphyseal defects, and spinal fusion; demineralised bone has also been used in a limited way clinically. However, sufficient osteoinduction in humans may require a higher concentration of BMPs and other growth factors than those found in demineralised bone.