Clinical need for bone morphogenetic proteins


Krishnakumar et al. [1] recently published a systemic review in International Orthopaedics on BClinical application of bone morphogenetic proteins for bone healing^ summarizing and interpreting findings from clinical studies on BMP use in fractures, non-unions and osteonecrosis (published 2000–2016; level of evidence I to IV). Surprisingly, the selection of articles for some reason missed several clinical studies and case reports including those published in International Orthopaedics [2–8]. For example, Das et al. [2] published the first randomized controlled clinical trial of 20 patients with Congenital Pseudarthrosis of the Tibia (CPT) associated with neurofibromatosis type I using rhBMP-7, an important indication recently approved for clinical testing by FDA using rhBMP-2 [9]. Instead, authors have preferably chosen manuscripts published in other journal supplements [1] decreasing thus the data source for appropriate conclusions. In the introduction, the authors claim that the discovery of BMPs by Urist took place at the end of the 19th century, referring to an unrelated journal supplement [10]; avoiding thus the quotation of the original discovery of BMPs published by Urist in 1965 [11] and recently acknowledged in International Orthopaedics in the orthopaedic heritage section as a tribute to Marshall Urist [12]. Consistently in this review [1], the authors referred to BMP preclinical studies with scaffolds unrelated to those superseding RCTs used for marketing approval of rhBMP-2 and rhBMP-7 based products. Under BComplications^ the authors discussed issues related to spinal surgery although their literature search did not include the use of BMPs in spinal fusion clinical studies systemically reviewed elsewhere [13, 14]. Finally, the conclusion is again based on the clinical use of BMPs in fractures, nonunions and osteonecrosis ascribing potential controversies to the heterogeneity of published studies. The authors also missed the systemic review on the clinical use of rhBMPs and the quality of RCTs suggesting that obtained results were not primarily heterogeneic [1], but in spine RCTs associated with side effects like cancer, which were mainly not reported although statistically insignificant [13–15].

DOI: 10.1007/s00264-017-3550-y


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@article{Vukievi2017ClinicalNF, title={Clinical need for bone morphogenetic proteins}, author={Slobodan Vuki{\vc}evi{\'c} and Lovorka Grgurevi{\'c} and Marko Pe{\vc}ina}, journal={International Orthopaedics}, year={2017}, volume={41}, pages={2415-2416} }