A Comparison of Mineral Bone Graft Substitutes for Bone Defects

Synthetic bone graft substitutes have evolved in response to the downsides of autograft and allograft. This article consolidates the literature regarding the use of mineral bone graft substitutes in the treatment of cavitary bone defects. No level I studies regarding their use in the treatment of bone tumors have been performed, but the clinical studies that have been published indicate that calcium sulfate resorbs too quickly and incites inflammatory reaction and hydroxyapatite resorbs too slowly and blocks new bone ingrowth; tricalcium phosphate and mineral bone graft composites have the biochemical profile that is most compatible with new bone formation. These studies also indicate that mineral bone grafts are safe and may be as effective as other graft options; however, radiographic interpretation may be inaccurate and no evidence exists to suggest that mineral bone graft substitutes are superior to no graft at all. The trauma literature has yielded numerous level I studies that indicate that calcium phosphate cements result in increased metaphyseal fracture stability, but have not yet detected any improvement in healing. Prospective randomized clinical trials in the treatment of bone tumors are necessary to properly delineate the real indications for bone grafting and to demonstrate the graft’s efficacy in this regard.