Bone morphogenetic proteins and bone defects: a systematic review

STUDY DESIGN: A systematic review of scientific literature. OBJECTIVE: The study aimed to determine whether bone morphogenetic proteins (BMPs) are more effective in treating bone defects than traditional techniques, such as grafting autologous bone. SUMMARY OF BACKGROUND DATA: BMPs were used in several human randomized controlled trials (RCTs). There are both logical arguments and an empirical basis for using RCTs to evaluate the effects of health care interventions and restrict systematic reviews to such a kind of study design. METHODS: An electronic search was made in the databases of MEDLINE, EMBASE (through MeSH and Emtree), and the Cochrane Central Register of Controlled Trials, extended to May 31, 2006, with no linguistic restrictions. RCTs that compare bone regeneration achieved through BMPs versus that obtained by traditional methods entered the study. RESULTS: The 17 publications that met the criteria, divided into subgroups by type of bone, were tabulated by salient characteristics and evaluated through the items proposed by van Tulder et al. However, as the studies differed widely (in terms of site, sample size, dosage of active principle, carrier, clinical and radiologic data recording), it was possible to carry out a metaanalysis of clinical and radiologic outcome only for the subgroup that evaluated the vertebrae, where it was observed that BMPs offer a slightly but statistically significant greater efficacy than do traditional techniques. CONCLUSIONS: The use of BMPs at the vertebrae can eliminate the need for surgery to harvest autologous bone. The only large study carried out on the other sites suggests that BMPs should be used at a concentration of 1.5 mg/mL to treat fractures of the tibia. However, further RCTs of good methodological quality are advisable so as to clarify the effectiveness of BMPs in clinical practice.