Bone morphogenetic protein (BMP) for fracture healing in adults
Open accessAbstract
BACKGROUND: Delay in fracture healing is a complex clinical and economic issue for patients and health services. OBJECTIVES: To assess the incremental effectiveness and costs of bone morphogenetic protein (BMP) on fracture healing in acute fractures and nonunions compared with standards of care. SEARCH STRATEGY: We searched The Cochrane Library (2008, Issue 4), MEDLINE, and other major health and health economics databases (to October 2008). SELECTION CRITERIA: Randomised controlled trials (RCTs) and full or partial economic evaluations of BMP for fracture healing in skeletally mature adults. DATA COLLECTION AND ANALYSIS: All clinical and economic data were extracted by one author and checked by another. MAIN RESULTS: Eleven RCTs, all at high risk of bias, and four economic evaluations were included. Apart from one study, the times to fracture healing were comparable between the BMP and control groups. There was some evidence for increased healing rates, without requiring a secondary procedure, of BMP compared with usual care control in acute, mainly open, tibial fractures (risk ratio (RR) 1.19, 95% CI 0.99 to 1.43). The pooled RR for achieving union for nonunited fractures was 1.02 (95% CI 0.90 to 1.15). One study found no difference in union for patients who had corrective osteotomy for radial malunions. Data from three RCTs indicated that fewer secondary procedures were required for acute fracture patients treated with BMP versus controls (RR 0.65, 95% CI 0.50 to 0.83). Adverse events experienced were infection, hardware failure, pain, donor site morbidity, heterotopic bone formation and immunogenic reactions. The evidence on costs for BMP-2 for acute open tibia fractures is from one large RCT. This indicates that the direct medical costs associated with BMP would generally be higher than treatment with standard care, but this cost difference may decrease as fracture severity increases. Limited evidence suggests that the direct medical costs associated with BMP could be offset by faster healing and reduced time off work for patients with the most severe open tibia fractures. AUTHORS' CONCLUSIONS: This review highlights a paucity of data on the use of BMP in fracture healing as well as considerable industry involvement in currently available evidence. There is limited evidence to suggest that BMP may be more effective than controls for acute tibial fracture healing, however, the use of BMP for treating nonunion remains unclear. The limited available economic evidence indicates that BMP treatment for acute open tibial fractures may be more favourable economically when used in patients with the most severe fractures.
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A Cochrane review concluded there is limited evidence that intraoperative BMP is more effective than control treatment for fracture healing.
“A Cochrane review on the effects of intraoperative application of BMP on fracture healing concluded that there is limited evidence that BMP is more effective than control treatment, and the efficacy of BMP for the treatment of nonunion remains unclear (103).”
From Methods to accelerate fracture healing – a narrative review from a clinical perspective (2024) · cites this paper as [103]
The Authors’ conclusions say there is limited evidence suggesting BMP may be more effective than controls for acute tibial fracture healing, and that its use for nonunion remains unclear. The citing sentence omits the acute-tibial-fracture restriction and states the possible benefit more firmly than the review does. (LLM, conf=0.86)
Experimental — accuracy not yet measuredThe efficacy of BMP for treatment of nonunion remains unclear.
“A Cochrane review on the effects of intraoperative application of BMP on fracture healing concluded that there is limited evidence that BMP is more effective than control treatment, and the efficacy of BMP for the treatment of nonunion remains unclear (103).”
From Methods to accelerate fracture healing – a narrative review from a clinical perspective (2024) · cites this paper as [103]
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“A Cochrane review on the effects of intraoperative application of BMP on fracture healing concluded that there is limited evidence that BMP is more effective than control treatment, and the ef fi cacy of BMP for the treatment of nonunion remains unclear (103).”
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- Authors
- Garrison, K. R., Shemilt, I., Donell, S., Ryder, J. J., Mugford, M., Harvey, I., Song, F., & Alt, V.
- Affiliations
- University of East Anglia (GB)
- Universitätsklinikum Gießen und Marburg (DE)
- Venue
- Cochrane Database of Systematic Reviews
- Publisher
- Wiley
- Published
- 2010-06-16
- Volume
- 2010
- Issue
- 6
- Pages
- CD006950-CD006950
- ISSN
- 1361-6137 (ISSN-L)
- 1465-1858
- PMC
- PMC6669254
- OpenAlex
- W2147144859
- Cited by
- 278
- References
- 66
- Citations by year
- 2026: 3 · 2025: 9 · 2024: 10 · 2023: 13 · 2022: 9 · 2021: 23 · 2020: 18 · 2019: 21 · 2018: 18 · 2017: 18 · 2016: 21 · 2015: 18 · 2014: 32 · 2013: 30 · 2012: 20
- FWCI
- 2.31
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Cochrane Database of Systematic Reviews (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- UCL Discovery (University College London) (submittedVersion)
- UEA Digital Repository (University of East Anglia) (submittedVersion)
- Funders
- National Institute for Health and Care Research (04/34/02)
- Topics
- Health Sciences › Medicine › Epidemiology › Bone fractures and treatments
- Physical Sciences › Engineering › Biomedical Engineering › Bone Tissue Engineering Materials
- Health Sciences › Medicine › Orthopedics and Sports Medicine › Bone health and osteoporosis research
- Keywords
- bone morphogenetic proteins, fracture healing, nonunion, acute fractures, tibial fractures, open fractures, corrective osteotomy, secondary procedures, heterotopic ossification, donor site morbidity, health care costs, economic evaluation, time to union, hardware failure, infection risk
- MeSH terms
- Adult, Cost-Benefit Analysis, Fractures, Ununited, Humans, Radius Fractures, Recombinant Proteins, Tibial Fractures, Randomized Controlled Trials as Topic, Transforming Growth Factor beta, Health Care Costs, Fracture Healing, Fractures, Malunited, Bone Morphogenetic Proteins, Fractures, Bone, Bone Morphogenetic Protein 2, Bone Morphogenetic Protein 7
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