Clinical Observations and Testing - Nanostructural Bioceramics: Advances in Chemically Bonded Ceramics - page 118

12.3 Orthopaedic Biomaterial Evaluation

12.3.1 Introduction

Nanostructural chemically bonded bioceramics (CBBCs) are
found only within a few orthopaedic applications so far. Below are
presented some studies where Ca-aluminate-based biomaterials
have been tested within orthopaedics.
Osteoporosis is by far the biggest cause of fractures. It affects
an estimated 75 million people only in Europe, the US, and Japan,
and the global prevalence is forecast to grow quickly. One in three
women that have passed menopause will experience osteoporotic
fractures, as will one in five men. There are an estimated two million
osteoporotic fractures every year in the US and Europe. Vertebral
compression fractures (VCFs) caused by low-energy trauma are
increasingly common in osteoporotic patients. For patients with
severe osteoporosis, simple daily life activities are enough to cause
painful collapse of one or several vertebrae. In individuals with less
pronounced osteoporosis, a low-energy type of loading such as falling
may cause compression fractures. The back pain lasts approximately
4-10 weeks, but in some cases it may persist for months with the
risk of becoming chronic and causing other complications such
as loss of lung capacity, decreased appetite, and even depression.
Conventional treatment includes bed rest, bracing, and analgesics for
pain relief. However, reduced physical activity accelerates bone loss,
whereby this treatment may further increase osteoporosis. Current
treatments for VCF are focused on vertebral body augmentation,
that is, strengthening of the vertebral body by injecting bone
cement. Augmentation also potentially includes therapies aimed at
the prevention of vertebral fractures and would involve the delivery
of biologically active compounds in order to increase bone mass.
The VCF market is dominated by two procedures, percutaneous
vertebroplasty (PVP) and kypho-vertebroplasty (KVP). These are
described in Chapter 10.
Poly(methyl methacrylate) (PMMA) bone cement is currently the
dominant commercially available material for vertebroplasty under
various brand names, and it has been extensively characterised in
the literature [23, 24]. Although PMMA is recognised as a successful