Biodegradable metals for bone defect repair: A systematic review and meta-analysis based on animal studies

Zhang, J. and Jiang, Y. and Shang, Z. and Zhao, B. and Jiao, M. and Liu, W. and Cheng, M. and Zhai, B. and Guo, Y. and Liu, B. and Shi, X. and Ma, B.

Bioact Mater (2021) 6: 4027–4052

DOI: 10.1016/j.bioactmat.2021.03.035

Abstract

Biodegradable metals are promising candidates for bone defect repair. With an evidence-based approach, this study investigated and analyzed the performance and degradation properties of biodegradable metals in animal models for bone defect repair to explore their potential clinical translation. Animal studies on bone defect repair with biodegradable metals in comparison with other traditional biomaterials were reviewed. Data was carefully collected after identification of population, intervention, comparison, outcome, and study design (PICOS), and following the inclusion criteria of biodegradable metals in animal studies. 30 publications on pure Mg, Mg alloys, pure Zn and Zn alloys were finally included after extraction from a collected database of 2543 publications. A qualitative systematic review and a quantitative meta-analysis were performed. Given the heterogeneity in animal model, anatomical site and critical size defect (CSD), biodegradable metals exhibited mixed effects on bone defect repair and degradation in animal studies in comparison with traditional non-degradable metals, biodegradable polymers, bioceramics, and autogenous bone grafts. The results indicated that there were limitations in the experimental design of the included studies, and quality of the evidence presented by the studies was very low. To enhance clinical translation of biodegradable metals, evidence-based research with data validity is needed. Future studies should adopt standardized experimental protocols in investigating the effects of biodegradable metals on bone defect repair with animal models.

Citation

Zhang, J., Jiang, Y., Shang, Z., Zhao, B., Jiao, M., Liu, W., Cheng, M., Zhai, B., Guo, Y., Liu, B., Shi, X., & Ma, B. (2021). Biodegradable metals for bone defect repair: A systematic review and meta-analysis based on animal studies. Bioact Mater, 6(11), 4027–4052. https://doi.org/10.1016/j.bioactmat.2021.03.035 Animal model, Biodegradable metals, Bone defect repair, Regulatory science, Safety and effectiveness, Systematic review and meta-analysis

Keywords

• Animal model
• Biodegradable metals
• Bone defect repair
• Regulatory science
• Safety and effectiveness
• Systematic review and meta-analysis