ORTHOBIOLOGIC

JOURNAL CLUB
WHAT IS ORTHOBIOLOGICS?
3 major properties of orthobiologics are:
• Osteoconduction
• Osteoinduction
• Osteogenesis
Osteoconduction is a bone formation process where an ingrowth
of the host cells, tissues, and vasculature occurs passively, aided
by an introduced scaffold.
Therefore, osteoconductive materials serve as a scaffold for the
host response to use in order to heal or form new bone
Examples of osteoconductive materials are :

• bone autograft(Cancellous autograft)

• bone allograft
• demineralized bone matrix (DBM)
• inert filler structures such as calcium ceramics
Osteoinduction is a bone formation process where new
bone is generated and supported by specific growth
factors from the introduced substance that promote
differentiation of mesenchymal stem cells to osteoblasts
and chondroblasts.
Examples of osteoinductive orthobiologics

• growth factors and signaling molecules such as

• BMPs
• platelet-derived growth factor (PDGF)
• fibroblast growth factor, and interleukins
• bone autograft
• bone marrow aspirate concentrate (BMAC)
• platelet-rich plasma (PRP).
Osteogenesis is the process by which
specific cellular elements within the
graft are able to synthesize new bone.
• AUTOLOGOUS BONE GRAFT has long been considered the “gold standard” for augmentation of bone
healing in the treatment of delayed unions and nonunions.

• Autologous bone grafts come in a few forms, including cancellous, vascularized cortical, and
nonvascularized cortical.

• Cancellous bone autograft has the greatest osteoconductive, osteoinductive, and osteogenic potential
of the, however cancellous autograft does not provide immediate structural support.Therefore, if the
intended function of the graft is to serve as a structural support, a cortical graft is preferred
Autologous iliac crest bone graft (ICBG) remains
the gold standard because it contains the
structure of cortical bone combined with the
bone healing properties of cancellous bone
autograft.
• PRP injected into the fracture site of a long bone atrophic
nonunion resulted in 87% (82/94) union at 4 months.

• A comparison of PRP with exchange intramedullary nailing

for long bone nonunions resulted in a healing rate of
approximately 93% in the PRP group compared with 80% in
the exchange nailing group. These studies point toward the
promising potential of PRP in fracture healing, although
further investigation is needed.
 PARATHYOID HORMONE
Recombinant human PTH (rhPTH), in the form of teriparatide, is the
only anabolic agent that is FDA-approved for use in osteoporosis
because its use is associated with an increase in bone mineral
density and decreased fracture risk

In a randomized controlled trial of 102 postmenopausal women with distal radius fractures treated with closed reduction
supplemented with PTH versus placebo, Aspenberg and colleagues 46 found a significantly shorter time to fracture healing
in patients treated with daily injections of 20 mg rhPTH compared with placebo.
 VITAMIN D AND CALCUIM
• vitamin D plays a role in bone healing through callous formation
and bone remodeling.

• Clinical studies have shown calcium and vitamin D

supplementation to significantly increase bone mineral density
and callus area in proximal humerus and distal radius fracture
patients, respectively.