title: Bone morphogenetic protein and orthopaedic surgery: can we legitimate its off-label use?
abstract: OBJECTIVE
  Bone morphogenetic proteins (BMP) are recombinant osteoinductive proteins with their primary role being to promote bone formation. The off-label use of BMP in orthopaedic surgery has dramatically increased. However, reports of complications with BMP have emerged, and the safety of these proteins in orthopaedics is questioned. The purpose of this review was to evaluate safe situations in which BMP should be used and situations in which their use should be restricted.
  
  
  METHODS
  We recorded all studies from PubMed database from 2002 (date of first authorisation for both BMPs) until January 2014 using "BMP" or "bone morphogenetic protein". Then we screened and extracted all studies dealing with orthopaedic surgery. All situations in which BMP were used, even cases reports, were considered, and complications reported were then listed.
  
  
  RESULTS
  Situations in which it seems safe and efficient to use BMP are long-bone nonunions, or arthrodesis as an alternative or combined to autograft in small-bone loss. Surgeons and patients should be aware of transient aseptic wound swelling when BMP is located superficially. The use of BMP in spine surgery for intersomatic fusion is efficient but should be restricted to approaches that respect the vertebral canal to avoid neurological complications.
  
  
  CONCLUSIONS
  This review is an off-label map of BMP use in orthopaedics during the past 10 years. Our results could provide a useful tool to help decisions around when to use a BMP in a specific complex, and sometimes off-label, situation.
authors.affiliation: Pediatric Orthopedic Department. Grenoble University Hospital, Grenoble Alpes University, BP 217, 38043, Grenoble Cedex 09, France, aurelien.courvoisier@gmail.com.
authors.forename: Aurélien
authors.initials: A
authors.lastname: Courvoisier
authors.forename: Frederic
authors.initials: F
authors.lastname: Sailhan
authors.forename: Olivier
authors.initials: O
authors.lastname: Laffenêtre
authors.forename: Laurent
authors.initials: L
authors.lastname: Obert
mesh_terms: D001174:Arthrodesis; D019485:Bone Morphogenetic Proteins / Q000494:pharmacology* / Q000627:therapeutic use*; D001842:Bone and Bones / Q000187:drug effects*; D005260:Female; D050723:Fractures, Bone / Q000601:surgery; D005599:Fractures, Ununited / Q000601:surgery; D006801:Humans; D056687:Off-Label Use; D019637:Orthopedic Procedures; D010012:Osteogenesis / Q000187:drug effects; D011994:Recombinant Proteins / Q000494:pharmacology / Q000627:therapeutic use; D013123:Spinal Fusion; D014182:Transplantation, Autologous
chemical_list: D019485:Bone Morphogenetic Proteins; D011994:Recombinant Proteins