Bone morphogenetic proteins for use in spinal surgery and long bone trauma surgery

Bone morphogenetic proteins (BMPs) are a group of growth factors capable of inducing the formation of bone. In addition to other vital tissue development functions, these proteins signal new bone growth through multiple pathways during the healing of bone. Osteoblasts are one cell type that respond to BMP signaling and are directly responsible for deposition of new bone. BMPs induce the differentiation of osetoprogenetor cells into osteoblasts and stimulate migration of these cells to areas of repair leading to the formation of new bone. Formation of new bone is critical for surgical success in spinal fusion surgeries and in the treatment of nonunion of fractured limbs. In order to achieve sufficient production of new bone for these procedures a bone graft can be used to induce new bone formation. More recently, application of recombinant human BMPs has been an available alternative or adjunct to bone graft procedures in order to achieve sufficient new bone formation. As with many growth factors, disruption of normal BMP signaling is routinely found in tumour cells. Therefore at therapeutic doses the potential of exogenous BMPs to increase cancer incidence is a logical concern. Additional potential adverse events specific to these biotherapeutics must also be evaluated before their use is considered in any application. The purpose of this report is to retrieve and review the existing evidence on clinical effectiveness and safety of BMPs for use in spinal fusion surgery and treatment of long bone trauma.