Possible Roles of Vitamin D in Bone Grafting.

Georgios Markopoulos,Vasileios S Nikolaou,Dimitrios C Iliopoulos,Panagiotis Lepetsos,Despina N Perrea

doi:10.7759/cureus.14688

Abstract

Bone grafting is one of the most commonly used options to treat large bone defects. Evidence has shown that vitamin D may affect osseointegration, a major component for successful bone grafting. In vitro studies have proved that implants coated with activated vitamin D stimulate bone production and reduce bone resorption around implants. Animal studies have noticed that oral administration of vitamin D may stimulate bone formation as well as strengthen and support the interaction between bone and implants. Vitamin D insufficiency may affect negatively the cortical peri-implant bone formation, suggesting a negative effect in graft incorporation. Few clinical studies have observed that vitamin D administration enhanced graft incorporation and bone formation, while severe vitamin D deficiency is associated with failed implant osseointegration. Even though there are encouraging results of vitamin D supplementation on graft incorporation in animal studies, the use of vitamin D as an adjuvant in bone grafting procedures cannot be fully supported at the moment. However, there is theoretical support in the use of vitamin D after surgery and the use of bone grafts to support the bone structure, relieve pain and increase graft absorption. Further experimental and clinical studies are required to support the administration of vitamin D and its analogues in such cases.

Highlights

BackgroundVitamin D is a fat-soluble vitamin regulating calcium and phosphorus metabolism in tissues
The level of vitamin D production is regulated in response to the serum levels of calcium, phosphorus and parathyroid hormone (PTH) [1,2]
In vitro studies by Satué et al have shown that ultraviolet radiation of titanium implants coated with 7dihydrocholesterol stimulates osteoblastic differentiation and vitamin D production [25], inhibit osteoclastogenesis [26], promote gene expression of bone formation markers and alkaline phosphatase activity [27], reduce extracellular matrix breakdown [28] and enhance the osteogenic differentiation of mesenchymal stem cells [29], around the implant

Summary

Introduction

Vitamin D is a fat-soluble vitamin regulating calcium and phosphorus metabolism in tissues. In vitro studies by Satué et al have shown that ultraviolet radiation of titanium implants coated with 7dihydrocholesterol stimulates osteoblastic differentiation and vitamin D production [25], inhibit osteoclastogenesis [26], promote gene expression of bone formation markers and alkaline phosphatase activity [27], reduce extracellular matrix breakdown [28] and enhance the osteogenic differentiation of mesenchymal stem cells [29], around the implant. Another preclinical study in dogs showed that local administration of vitamin D stimulated new bone formation, increased bone density and improved implant stability around surgically created sockets in the mandible [37] In another experimental study in rabbits, 28 implants inserted in the tibia and coated with 1,25-(OH)2D3 demonstrated a trend for better osseointegration in comparison with uncoated implants [38]. Bryce and MacBeth reported a case of a failed osseointegration of a dental implant in a 29-year old with a severe deficiency of vitamin D [47]

Conclusions

Disclosures

14. Katayama Y

Findings

16. Holick MF