title: The incorporation of platelet-rich plasma into calcium phosphate cement enhances bone regeneration in osteoporosis.
abstract: BACKGROUND
  Polymethyl methacrylate (PMMA) bone cement is widely used for osteoplasty. However, previous studies have demonstrated the adverse effects of PMMA due to its excessive stiffness and heat production. Recently, calcium phosphate cement (CPC) that overcomes those negative effects has been successfully applied in osteoplasty. The potential problem of CPC is markedly less initial stiffness. It leads to progressive, repeated collapse in the treated vertebra before CPC has been replaced by new bone that would provide substantial improvement in compressive strength and stiffness. The activated platelets in platelet-rich plasma (PRP) release a high concentration of growth factors which play an important role in bone healing.
  
  
  OBJECTIVE
  To investigate whether PRP could accelerate the osteoconduction of CPC and enhance the bone strength of the treated vertebra in an animal model.
  
  
  METHODS
  Controlled animal study.
  
  
  METHODS
  Laboratory animal study,
  
  
  METHODS
  Thirty-two female Sprague-Dawley rats were ovariectomized at 8 weeks of age. After 3 months, they were randomly divided into 4 groups and received cement augmentation in the fifth caudal spine with different filler materials; sham-operated rats (S), PMMA (P), CPC (C), and CPC + PRP (CP). Bone mineral density (BMD) and trabecular type-associated morphological parameters, including trabecular bone volume fraction and trabecular thickness in the augmented caudal spine, were evaluated by micro-computed tomography (mirco-CT) 2 weeks after the cementoplasty. Histological analysis was also performed to compare the bone regeneration.
  
  
  RESULTS
  The trabecular bone volume fraction in the CP group was significantly greater than those of all the other groups. Trabecular thickness was higher in the CP group than the S and P groups. This augmented trabecular structure in the CP group accordingly showed higher BMD. Histological evaluations showed significantly more bone regeneration in the CP group.
  
  
  CONCLUSIONS
  There has been a concern that the effect of PRP would be dependent on the species, and might show different results in humans. Baseline values of micro-CT analysis were not measured, which could have provided exact evidence of the changes in trabecular micro-architecture parameters and cement resorption profiles. Finally, caudal vertebrae with filler materials used in biological study should have been compared by their mechanical properties using biomechanical evaluations for a more coherent study, which was not possible due to technical problems.
  
  
  CONCLUSIONS
  Incorporating PRP into CPC could accelerate osteoconduction in the augmented vertebra leading to improvement of trabecular bone microarchitecture and BMD in rats.
authors.forename: Ah-Reum
authors.initials: AR
authors.lastname: Cho
authors.forename: Hae-Kyu
authors.initials: HK
authors.lastname: Kim
authors.forename: Jae-Young
authors.initials: JY
authors.lastname: Kwon
authors.forename: Tae-Kyun
authors.initials: TK
authors.lastname: Kim
authors.forename: Yun-Mi
authors.initials: YM
authors.lastname: Choi
authors.affiliation: Department of Anesthesia and Pain Medicine, School of Medicine, Pusan National University; Medical Research Institute, Pusan National University Hospital, Busan, Republic of Korea.
authors.forename: Kyung-Hoon
authors.initials: KH
authors.lastname: Kim
mesh_terms: D000818:Animals; D001843:Bone Cements / Q000627:therapeutic use*; D015519:Bone Density; D001861:Bone Regeneration; D002130:Calcium Phosphates / Q000627:therapeutic use*; D060826:Cementoplasty / Q000379:methods*; D004195:Disease Models, Animal; D005260:Female; D006801:Humans; D010024:Osteoporosis / Q000628:therapy*; D053657:Platelet-Rich Plasma; D051381:Rats; D017207:Rats, Sprague-Dawley; D014057:Tomography, X-Ray Computed
chemical_list: D001843:Bone Cements; D002130:Calcium Phosphates; C020243:calcium phosphate