In vivo and clinical application of strontium-enriched biomaterials for bone regeneration: A systematic review

doi:10.1302/2046-3758.66.BJR-2016-0311.R1

. 2017 Jun;6(6):366-375.

doi: 10.1302/2046-3758.66.BJR-2016-0311.R1.

In vivo and clinical application of strontium-enriched biomaterials for bone regeneration: A systematic review

N Neves¹, D Linhares², G Costa³, C C Ribeiro⁴, M A Barbosa⁵

Affiliations

¹ Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Universidade do Porto, Rua Alfredo Allen, 208, 4200-135 Porto and Researcher, INEB - Instituto de Engenharia Biomédica, Universidade do Porto, Rua Alfredo Allen, 208, 4200-135 Porto and Lecturer Faculty of Medicine, University of Porto, Surgery Department, Alameda Prof. Hernâni Monteiro, 4200-319 Porto and Orthopaedic Surgeon Centro Hospitalar de São João, Orthopedic Department, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal nsmneves@gmail.com.
² Orthopaedic Department, Centro Hospitalar de São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto and Researcher and Lecturer, MEDCIDS - Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319 Porto Portugal.
³ Faculty of Medicine, Surgery Department, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, and Orthopaedic Surgeon, Centro Hospitalar de São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal.
⁴ Instituto de Investigação e Inovação em Saúde, Rua Alfredo Allen, 208, 4200-135 Porto, Portugal and Researcher, INEB - Instituto de Engenharia Biomédica, Universidade do Porto, Rua Alfredo Allen, 208, 4200-135 Porto and Professor, ISEP - Instituto Superior de Engenharia do Porto, Instituto Politécnico do Porto, Rua Dr. António Bernardino de Almeida 431, 4249-015 Porto, Portugal.
⁵ Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Rua Alfredo Allen, 208, 4200-135 Porto and Researcher, INEB - Instituto de Engenharia Biomédica, Universidade do Porto, Rua Alfredo Allen, 208, 4200-135 Porto and Professor, ICBAS-Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Rua de Jorge Viterbo Ferreira 228, 4050-313 Porto, Portugal.

PMID: 28600382
PMCID: PMC5492369
DOI: 10.1302/2046-3758.66.BJR-2016-0311.R1

In vivo and clinical application of strontium-enriched biomaterials for bone regeneration: A systematic review

N Neves et al. Bone Joint Res. 2017 Jun.

. 2017 Jun;6(6):366-375.

doi: 10.1302/2046-3758.66.BJR-2016-0311.R1.

Authors

N Neves¹, D Linhares², G Costa³, C C Ribeiro⁴, M A Barbosa⁵

Affiliations

¹ Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Universidade do Porto, Rua Alfredo Allen, 208, 4200-135 Porto and Researcher, INEB - Instituto de Engenharia Biomédica, Universidade do Porto, Rua Alfredo Allen, 208, 4200-135 Porto and Lecturer Faculty of Medicine, University of Porto, Surgery Department, Alameda Prof. Hernâni Monteiro, 4200-319 Porto and Orthopaedic Surgeon Centro Hospitalar de São João, Orthopedic Department, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal nsmneves@gmail.com.
² Orthopaedic Department, Centro Hospitalar de São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto and Researcher and Lecturer, MEDCIDS - Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319 Porto Portugal.
³ Faculty of Medicine, Surgery Department, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, and Orthopaedic Surgeon, Centro Hospitalar de São João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal.
⁴ Instituto de Investigação e Inovação em Saúde, Rua Alfredo Allen, 208, 4200-135 Porto, Portugal and Researcher, INEB - Instituto de Engenharia Biomédica, Universidade do Porto, Rua Alfredo Allen, 208, 4200-135 Porto and Professor, ISEP - Instituto Superior de Engenharia do Porto, Instituto Politécnico do Porto, Rua Dr. António Bernardino de Almeida 431, 4249-015 Porto, Portugal.
⁵ Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Rua Alfredo Allen, 208, 4200-135 Porto and Researcher, INEB - Instituto de Engenharia Biomédica, Universidade do Porto, Rua Alfredo Allen, 208, 4200-135 Porto and Professor, ICBAS-Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Rua de Jorge Viterbo Ferreira 228, 4050-313 Porto, Portugal.

PMID: 28600382
PMCID: PMC5492369
DOI: 10.1302/2046-3758.66.BJR-2016-0311.R1

Abstract

Objectives: This systematic review aimed to assess the in vivo and clinical effect of strontium (Sr)-enriched biomaterials in bone formation and/or remodelling.

Methods: A systematic search was performed in Pubmed, followed by a two-step selection process. We included in vivo original studies on Sr-containing biomaterials used for bone support or regeneration, comparing at least two groups that only differ in Sr addition in the experimental group.

Results: A total of 572 references were retrieved and 27 were included. Animal models were used in 26 articles, and one article described a human study. Osteoporotic models were included in 11 papers. All articles showed similar or increased effect of Sr in bone formation and/or regeneration, in both healthy and osteoporotic models. No study found a decreased effect. Adverse effects were assessed in 17 articles, 13 on local and four on systemic adverse effects. From these, only one reported a systemic impact from Sr addition. Data on gene and/or protein expression were available from seven studies.

Conclusions: This review showed the safety and effectiveness of Sr-enriched biomaterials for stimulating bone formation and remodelling in animal models. The effect seems to increase over time and is impacted by the concentration used. However, included studies present a wide range of study methods. Future work should focus on consistent models and guidelines when developing a future clinical application of this element.Cite this article: N. Neves, D. Linhares, G. Costa, C. C. Ribeiro, M. A. Barbosa. In vivo and clinical application of strontium-enriched biomaterials for bone regeneration: A systematic review. Bone Joint Res 2017;6:366-375. DOI: 10.1302/2046-3758.66.BJR-2016-0311.R1.

Keywords: Biomaterials; Bone; Strontium.

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Conflict of interest statement

ICMJE Conflicts of Interest: None declared

Figures

**Fig.1**
Flow diagram showing the study screening process.

**Fig. 2**
Summary of study results on gene and protein expression. When different results from different study times were available, they were stated.

See this image and copyright information in PMC

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References

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[1] Alves SM, Economou T, Oliveira C, et al. Osteoporotic hip fractures: bisphosphonates sales and observed turning point in trend. A population-based retrospective study. Bone 2013;53:430-436. - PubMed

[2] Alves SM, Economou T, Oliveira C, et al. Osteoporotic hip fractures: bisphosphonates sales and observed turning point in trend. A population-based retrospective study. Bone 2013;53:430-436. - PubMed

[3] Matassi F, Nistri L, Chicon Paez D, Innocenti M. New biomaterials for bone regeneration. Clin Cases Miner Bone Metab 2011;8:21-24. - PMC - PubMed

[4] Matassi F, Nistri L, Chicon Paez D, Innocenti M. New biomaterials for bone regeneration. Clin Cases Miner Bone Metab 2011;8:21-24. - PMC - PubMed

[5] Lin K, Liu P, Wei L, et al. Strontium substituted hydroxyapatite porous microspheres: surfactant-free hydrothermal synthesis, enhanced biological response and sustained drug release. Chem Eng J 2013;222:49-59.

[6] Lin K, Liu P, Wei L, et al. Strontium substituted hydroxyapatite porous microspheres: surfactant-free hydrothermal synthesis, enhanced biological response and sustained drug release. Chem Eng J 2013;222:49-59.

[7] Goldhahn J, Scheele WH, Mitlak BH, et al. Clinical evaluation of medicinal products for acceleration of fracture healing in patients with osteoporosis. Bone 2008;43:343-347. - PubMed

[8] Goldhahn J, Scheele WH, Mitlak BH, et al. Clinical evaluation of medicinal products for acceleration of fracture healing in patients with osteoporosis. Bone 2008;43:343-347. - PubMed

[9] Liu HY, Wu AT, Tsai CY, et al. The balance between adipogenesis and osteogenesis in bone regeneration by platelet-rich plasma for age-related osteoporosis. Biomaterials 2011;32:6773-6780. - PubMed

[10] Liu HY, Wu AT, Tsai CY, et al. The balance between adipogenesis and osteogenesis in bone regeneration by platelet-rich plasma for age-related osteoporosis. Biomaterials 2011;32:6773-6780. - PubMed

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In vivo and clinical application of strontium-enriched biomaterials for bone regeneration: A systematic review

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In vivo and clinical application of strontium-enriched biomaterials for bone regeneration: A systematic review

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