“Why is Cancer a Contraindication to Using BMP with Bone Grafting?”

Quick Review #81 - #bonemorphogenicprotein #surgery #dentalimplants #bonegrafting #doctorgallagher #oralsurgery #oralsurgeon #dentist #dentistry #dental Bone Morphogenetic Proteins (BMPs) are a group of growth factors known for their ability to stimulate bone formation. They are often used in orthopedic surgery and dentistry to enhance bone healing and bone grafting procedures. However, there are certain contraindications to the use of BMPs, including cancer: 1. Stimulation of Tumor Growth: BMPs are powerful growth factors that can stimulate cell proliferation. In the context of cancer, there is a concern that BMPs could potentially stimulate the growth of existing cancer cells or contribute to the development of new cancers. The growth-promoting properties of BMPs might not distinguish between healthy cells and malignant cells. 2. Interaction with Cancer Pathways: Some cancers might have pathways or mechanisms that are similar to or influenced by the pathways used by BMPs. Using BMPs in a patient with cancer could inadvertently activate these pathways, leading to tumor progression or metastasis. The use of Bone Morphogenetic Protein (BMP) in bone grafting procedures, especially in patients with cancer, has raised concerns due to potential risks associated with its use. Studies have shown that recombinant human bone morphogenetic protein 2 (rhBMP-2), a common ingredient in BMP products like Medtronic’s Infuse Bone Graft, may be linked to an increased risk of cancer. Research has found higher rates of cancer among patients who received treatments involving BMP compared to those who did not. This has led to cautious use or contraindication of BMP in patients with active malignancies or a history of cancer. One significant concern is that BMPs, being potent growth factors, could potentially stimulate the growth of cancer cells. This risk was highlighted when the FDA rejected a product (Amplify) with a higher dose of rhBMP-2 due to a substantially increased risk of cancer. Studies have suggested that patients treated with Amplify were up to 2.5 times more likely to develop cancer within a year of treatment, and this risk increased fivefold after three years. Additionally, adverse events such as pain, infections, inflammation, and even male sterility have been reported in association with BMP use. References: 1. Boden, S. D., Kang, J., Sandhu, H., & Heller, J. G. (2002). Use of recombinant human bone morphogenetic protein-2 to achieve posterolateral lumbar spine fusion in humans: a prospective, randomized clinical pilot trial: 2002 Volvo Award in clinical studies. Spine (Phila Pa 1976), 27, 2662–2673. 2. Mi-joo Kim, Kwang-mahn Kim, Jin Kim, & Kyoung-nam Kim, 2014, “BMP-2 promotes oral squamous carcinoma cell invasion by inducing CCL5 release” in PubMed. 3. ChatGPT. 2023.