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1.
Radiographic and clinical outcomes of silicate-substituted calcium phosphate (SiCaP) bone grafts in spinal fusion: Systematic review and meta-analysis.
Cottrill, E, Premananthan, C, Pennington, Z, Ehresman, J, Theodore, N, Sciubba, DM, Witham, T
Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia. 2020;:353-366
Abstract
Pseudarthrosis continues to affect a nontrivial proportion of spine fusion patients. Given its ties to poorer patient outcomes and high reoperation rates, there remains great interest in interventions aimed at reducing the rates of nonunion. Recently, silicate-substituted calcium phosphate (SiCaP) bone grafts have been suggested to improve fusion rates, yet there exists no systematic review of the body of evidence for SiCaP grafts. Here, we present the first such review along with a meta-analysis of the effect of SiCaP bone grafts on fusion rates. Using the PubMed, Embase, and Web of Science databases, we queried the English-language literature for all studies examining the effect of SiCaPs on spinal fusion. Primary endpoints were: 1) radiographic fusion rate at last follow-up and 2) postoperative improvements in Visual Analog Scale (VAS) pain scores and Oswestry Disability Index (ODI) at last follow-up. Meta-analyses were performed for each endpoint using random effects. Ten articles (694 patients treated with SiCaP bone grafts) were included. Among SiCaP-treated patients, 93% achieved radiographic fusion (range: 79-100%), with comparable rates across subgroups. Meta-analysis of the three randomized controlled trials demonstrated no difference in fusion rates between SiCaP-treated patients and patients receiving grafts with recombinant human bone morphogenetic protein-2 (rhBMP-2) (OR: 1.11; p = 0.83). Patients treated with SiCaP bone grafts experienced significant improvements in VAS back pain (-3.3 points), VAS leg pain (-4.8 points), and ODI (-31.6 points) by last follow-up (p < 0.001 for each). Additional high-quality research is needed to evaluate the relative cost-effectiveness of SiCaP bone grafts in spinal fusion.
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2.
Calcium and Phosphate Metabolism, Blood Lipids and Intestinal Sterols in Human Intervention Studies Using Different Sources of Phosphate as Supplements-Pooled Results and Literature Search.
Trautvetter, U, Ditscheid, B, Jahreis, G, Glei, M
Nutrients. 2018;(7)
Abstract
Phosphates are associated with negative physiological effects. The objectives of this publication were to compare differential effects of supplementation with calcium phosphate or phosphate alone in healthy humans. Four adult human studies were conducted with pentacalcium hydroxy-trisphosphate supplementation (CaP; 90 subjects) and their data were pooled for assessment. For literature search; PubMed and ISI Web of Knowledge were used and 21 items were assigned to three main topics. The pooled study results show that following CaP supplementation, faecal calcium and phosphorus and urinary calcium were increased, blood lipids were positively modulated, and faecal bile acids were increased, as compared with placebo. The literature search reveals that following calcium phosphate supplementation, urinary calcium was increased. Following solely phosphate supplementation, urinary phosphorus was increased and urinary calcium was decreased. Postprandial calcium concentrations were increased following calcium phosphate supplementation. Postprandial phosphate concentrations were increased following solely phosphate supplementation. Calcium phosphate supplementation resulted in rather positively modulated blood lipids and gut-related parameters. The presented results show the relevance to distinguish between calcium phosphate and solely phosphate supplementations, and the importance of a balanced calcium and phosphorus intake.
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3.
Growth factors and beta-tricalcium phosphate in the treatment of periodontal intraosseous defects: A systematic review and meta-analysis of randomised controlled trials.
Cãlin, C, Pãtraşcu, I
Archives of oral biology. 2016;:44-54
Abstract
OBJECTIVE To evaluate the effectiveness at different points in time, of recombinant human platelet-derived growth factor-BB (rhPDGF-BB) coated onto a beta-tricalcium phosphate (β-TCP) carrier compared to β-TCP alone, or to recombinant human growth/differentiation factor-5 (rhGDF-5) adsorbed onto a β-TCP scaffold in intraosseous periodontal defects. DESIGN A digital search for randomised controlled trials (RCTs) was conducted on MEDLINE/PubMed. The quality of reporting and the risk of bias of the included RCTs were assessed using the CONSORT guidelines and the Cochrane risk of bias tool. The difference between the means of the outcomes at baseline and at follow-up for each group was tested using the Student's t-test for paired samples. The difference between the means of the outcome changes at follow-up between groups was analysed using the Student's t-test for two independent samples. Prior to each analysis a test of homogeneity of variances (Ansari-Bradley) was performed. RESULTS From 11 articles assessed for eligibility, 5 RCTs were included in this review. The risk of bias was considered to be low in 2 articles, medium in 1 study and high in 2 studies. CONCLUSIONS In the treatment of periodontal intraosseous defects the application of rhPDGF-BB/β-TCP improved all outcomes when compared to β-TCP at 6 months follow-up. Either rhPDGF-BB/β-TCP or rhGDF-5/β-TCP seemed to provide similar results in terms of probing pocket depth (PPD) reduction and clinical attachment level (CAL) gain. The application of rhGDF-5/β-TCP resulted in a more pronounced reduction in gingival recession (GR) depth at 6 months follow-up compared to rhPDGF-BB/β-TCP.
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4.
Histological outcomes of sinus augmentation for dental implants with calcium phosphate or deproteinized bovine bone: a systematic review and meta-analysis.
Wu, J, Li, B, Lin, X
International journal of oral and maxillofacial surgery. 2016;(11):1471-1477
Abstract
This study compared the histological outcomes of deproteinized bovine bone (DBB) and technically derived calcium phosphate for sinus floor augmentation. MEDLINE, PubMed, Cochrane, EMBASE, and Google Scholar databases were searched until April 2015 with the following key words: dental implants, augmentation/augmented, calcium phosphate/ceramic/tricalcium phosphate, bovine bone/Bio-Oss, deproteinized/anorganic. Randomized controlled trials (RCTs) and two-arm prospective/retrospective studies that used DBB or biphasic calcium phosphate/tricalcium phosphate (BCP/TCP) for sinus augmentation with quantitative results were included. Outcomes were the percentage of new bone formed and percentage of surface contact between the graft material and new bone (bone-to-graft contact). Four RCTs and one prospective study were included, with a total of 110 patients and 145 implants. All studies reported the percentage of new vital bone; however, large heterogeneity was present (Q=15.23, P=0.004, I2=73.8%). BCP/TCP was associated with a higher percentage of new bone, but the pooled results did not reach significance (pooled standardized mean difference (SMD)=0.145, 95% confidence interval (CI) -0.488 to 0.778, P=0.654). Only two studies reported bone-to-graft contact, and BCP/TCP was associated with significantly lower bone-to-graft contact (pooled SMD=-0.807, 95% CI -1.276 to -0.337, P=0.001). This meta-analysis does not allow us to conclude superiority of one particular material with respect to histological outcomes.
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5.
Effect of lanthanum carbonate versus calcium-based phosphate binders in dialysis patients: a meta-analysis.
Zhai, CJ, Yu, XS, Sun, QL, Li, L, Zhang, LT, Zhou, AY, Wang, R
Clinical nephrology. 2014;(6):372-8
Abstract
BACKGROUND The effects of lanthanum carbonate (LC) vs. calciumbased phosphate binders in dialysis patients have been a matter of debate. METHODS We electronically searched PubMed, Embase, CENTRAL, and CBM for all randomized controlled trials comparing LC with calcium-based phosphate binders in adult dialysis patients. Quality assessment was performed using the Cochrane risk of bias tool. Metaanalysis was conducted by RevMan 5.2. RESULTS Nine studies were eligible for our meta-analysis. There was no significant difference in all-cause mortality (RR 0.84, 95% CI 0.25 - 2.83) and cardiovascular events (RR 0.84, 95% CI 0.55 - 1.29) between LC and calcium-based phosphate binders. LC was associated with similar proportions of phosphate-controlled patients (RR 0.63, 95% CI 0.27 - 1.44) and lower incidence of hypercalcemia (RR 0.13, 95% CI 0.05 - 0.35) in comparison to calcium-based phosphate binders. Compared with calcium salts, LC was associated with significantly lower serum calcium, similar serum Ca x P product and higher serum iPTH. CONCLUSION Despite the trends observed, we found no statistically significant differences in all-cause mortality and cardiovascular events between LC and calcium-based phosphate binders in dialysis patients. The conclusion was limited by lack of large sample and long-term trials. LC could reduce the incidence of hypercalcemia while comparable with calcium-based phosphate binders in reducing serum phosphorus level.
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6.
Meta-analysis comparing sevelamer and calcium-based phosphate binders on cardiovascular calcification in hemodialysis patients.
Zhang, Q, Li, M, Lu, Y, Li, H, Gu, Y, Hao, C, Chen, J
Nephron. Clinical practice. 2010;(4):c259-67
Abstract
BACKGROUND Accelerated cardiovascular calcification often occurs in patients with cardiovascular disease who are on hemodialysis. We performed a meta-analysis to compare the effects of sevelamer hydrochloride and calcium-based phosphate binders on coronary artery calcification, C-reactive protein, alkaline phosphatase and intact parathyroid hormone in patients undergoing hemodialysis. METHODS We used the key words 'sevelamer' and 'Renagel' to retrieve studies from Medline, the Cochrane Library and conference proceedings. The trials searched were evaluated for eligibility and quality, and then the data were abstracted and analyzed. RESULTS We ultimately included 14 studies that enrolled a total of 3,271 patients. There was no difference in coronary artery calcium progression between the calcium and the sevelamer groups. Use of sevelamer, rather than calcium-based phosphate binders, was associated with significantly lower C-reactive protein levels (weighted mean difference (WMD) -1.42; 95% confidence interval (CI) -2.09 to -0.74), higher alkaline phosphatase levels (WMD 22.66; 95% CI 13.81-31.5) and higher intact parathyroid hormone levels (WMD 55.85; 95% CI 14.47-97.24). CONCLUSIONS Treatment with sevelamer did not affect cardiovascular calcification, but there was a trend for lower C-reactive protein levels, higher alkaline phosphatase levels and intact parathyroid hormone levels among sevelamer-treated patients.
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7.
Discussion. Calcium phosphate cements in skull reconstruction: a meta-analysis.
Bartlett, SP
Plastic and reconstructive surgery. 2010;(4):1310
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8.
Calcium phosphate cements in skull reconstruction: a meta-analysis.
Afifi, AM, Gordon, CR, Pryor, LS, Sweeney, W, Papay, FA, Zins, JE
Plastic and reconstructive surgery. 2010;(4):1300-1309
Abstract
BACKGROUND This work addresses the controversy regarding the indications and results of calcium phosphate cements in skull reconstruction through a meta-analysis of the published literature. METHODS A PubMed search for articles reporting the use of calcium phosphate cements for skull reconstruction was performed. Data collected included age, volume of cement, defect size, material used, length of follow-up, placement in communication with paranasal sinuses or in irradiated fields, and complications. RESULTS Nineteen articles met the authors' inclusion criteria. The mean rates of complications were as follows: total complications, 13 percent (range, 0 to 62 percent); major complications, 9 percent (range, 0 to 62 percent); minor complications, 2 percent (range, 0 to 5 percent); infection, 5 percent (range, 0 to 22 percent); reoperation, 14 percent (range, 0 to 62 percent); and secondary surgery for contour correction, 1 percent (range, 0 to 12 percent). There was significant heterogeneity in the estimated rate of total and major complications, infection, and reoperation (p < 0.001), but minor complications and secondary contour correction had less heterogeneity (p = 0.58 and p = 0.78, respectively). Radiotherapy and communication with the paranasal sinuses significantly increased the complication rate (p < 0.05). Duration between surgery and complications averaged 17.5 months (range, 1 to 89 months). CONCLUSIONS When mean complication rate and complication range of calcium phosphate cements in our meta-analysis were compared with previous large cranioplasty studies using methylmethacrylate or autogenous bone, calcium phosphate fared no better, and sometimes fared worse, than these other modalities. Calcium phosphate, therefore, should only be used selectively, and prospective long-term studies are needed to further refine its role in skull reconstruction.
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9.
The use of calcium phosphate bone cement in fracture treatment. A meta-analysis of randomized trials.
Bajammal, SS, Zlowodzki, M, Lelwica, A, Tornetta, P, Einhorn, TA, Buckley, R, Leighton, R, Russell, TA, Larsson, S, Bhandari, M
The Journal of bone and joint surgery. American volume. 2008;(6):1186-96
Abstract
BACKGROUND Available options to fill fracture voids include autogenous bone, allograft bone, and synthetic bone materials. The objective of this meta-analysis was to determine whether the use of calcium phosphate bone cement improves clinical and radiographic outcomes and reduces fracture complications as compared with conventional treatment (with or without autogenous bone graft) for the treatment of fractures of the appendicular skeleton in adult patients. METHODS Multiple databases, online registers of randomized controlled trials, and the proceedings of the meetings of major national orthopaedic associations were searched. Published and unpublished randomized controlled trials were included, and data on methodological quality, population, intervention, and outcomes were abstracted in duplicate. Data were pooled across studies, and relative risks for categorical outcomes and weighted mean differences for continuous outcomes, weighted according to study sample size, were calculated. Heterogeneity across studies was determined, and sensitivity analyses were conducted. RESULTS We identified eleven published and three unpublished randomized controlled trials. Of the fourteen studies, six involved distal radial fractures, two involved femoral neck fractures, two involved intertrochanteric femoral fractures, two involved tibial plateau fractures, one involved calcaneal fractures, and one involved multiple types of metaphyseal fractures. All of the studies evaluated the use of calcium phosphate cement for the treatment of metaphyseal fractures occurring primarily through trabecular, cancellous bone. Autogenous bone graft was used in the control group in three studies, and no graft material was used in the remaining studies. Patients managed with calcium phosphate had a significantly lower prevalence of loss of fracture reduction in comparison with patients managed with autograft (relative risk reduction, 68%; 95% confidence interval, 29% to 86%) and had less pain at the fracture site in comparison with controls managed with no graft (relative risk reduction, 56%; 95% confidence interval, 14% to 77%). We were unable to compare pain at the bone-graft donor site between the studies because of methodological reasons. Three studies independently demonstrated improved functional outcomes when the use of calcium phosphate was compared with the use of no grafting material. CONCLUSIONS The use of calcium phosphate bone cement for the treatment of fractures in adult patients is associated with a lower prevalence of pain at the fracture site in comparison with the rate in controls (patients managed with no graft material). Loss of fracture reduction is also decreased in comparison with that in patients managed with autogenous bone graft.