A New Tool For Bone Regeneration

When it comes to rebuilding bones, one of the tools in the orthopedic surgeon’s toolbox is bone grafts. This involves, to oversimplify it a bit, gluing particles of bone to where bone needs rebuilding. However, this comes with problems, most notably:

• that the bone tissue and the adhesive “glue” need to be prepared separately and mixed in situ, which is fiddly, to say the least
• that the resultant mixture mixed in situ will usually be unevenly mixed, resulting in weak bonding and degradation over time
• having any more of one part or the other in any given site means that bone regeneration and adhesion become a “pick one” matter, when both are critically needed

You may be wondering: why can’t they mix them before putting them in?

And the answer is: because then either the glue will set the bone prematurely (and now we have a clump of bone outside of the body which is not what we wanted), or else the glue will have issues with setting in situ, and now we have bone tissue running down the inside of someone’s leg and setting somewhere else, which is also not what we want.

These kinds of problems may seem a little more “arts and crafts” than “orthopedic surgery”, but they are the kind of nitty-gritty real-life real challenges that actually get in the way of healing patients’ bones.

The new solution

Biomaterial research scientists have developed an injectable hydrogel (containing all the necessary ingredients* that uses light to achieve cross-linking of bone particles and mineralization without any of the above being necessary. In again oversimplified terms: they inject the hydrogel where it’s needed, and then irradiate the site with harmless visible light which instantly sets it in place. As to how the light gets in there: it’s just very shiny, like candling an egg to see inside, or like how you can still approximately see bright light even with your eyes closed.

*alginate (natural polysaccharide derived from brown algae), RGD peptide-containing mussel** adhesive protein, calcium ions, phosphonodiols, and a photoinitiator.

**unclear whether this would trigger a shellfish allergy. Probably kosher per “פיקוח נפש” and Talmud Yoma 85b, but we are a health science newsletter, not Talmudic scholars, so please talk to your Rabbi. Probably halal per Qur’an 5:4 and failing that, the same principle as previously mentioned, expressed in Qur’an 5:3 and 6:119, but once again, your humble writer here is no Mufti, so please talk to your Imam. As for if you are vegetarian or vegan, then that is for you to decide whether to take a “medications with animal ingredients are unfortunate but necessary” stance, as most do. This vegan writer would (she’d grumble about it, though, and at least try to find an acceptable alternative first).

Back to the more general practicalities…

How it works, in less oversimplified terms:

❝The coacervate-based formulation, which is immiscible in water, ensures that the hydrogel retains its shape and position after injection into the body. Upon visible light irradiation, cross-linking occurs, and amorphous calcium phosphate, which functions as a bone graft material, is simultaneously formed. This eliminates the need for separate bone grafts or adhesives, enabling the hydrogel to provide both bone regeneration and adhesion.❞

See the paper: Visible light-induced simultaneous bioactive amorphous calcium phosphate mineralization and in situ crosslinking of coacervate-based injectable underwater adhesive hydrogels for enhanced bone regeneration

“That’s great, but I was hoping for something I can do right now, ideally at home”

If getting glued back together was not on your bucket list, that’s understandable. There’s still a lot you can do for bone density; here’s a quick overview:

• Get it checked. Yes, this first, if you haven’t already! You want a basis for comparison later. Book a bone density scan. See for example this case study with bone density scans at each end: 21% Stronger Bones in a Year at 62? Yes, It’s Possible (No Calcium Supplements Needed!)
• Enjoy a diet rich in calcium and vitamin D yes, but be aware that you can have too much of a good thing, and doing so will result in more harm than good, including (paradoxically) for your bones. See: Vitamin D + Calcium: Too Much Of A Good Thing?
• Enjoy a diet rich is phosphorus, potassium, and magnesium, which things are also necessary for bone health, and in which people are much more likely to be deficient (especially magnesium). If you’re going to supplement, then there are very big difference in the efficacy of different kinds of magnesium supplement (brace yourself; the cheapest and most common kind barely does anything at all). See: Which Magnesium? (And: When?)
• Enjoy a diet rich in high quality protein—collagen is very useful, but if you want a plant-based approach, don’t worry, our body can and will make it for yourself if you give it a hand—and vitamin C to help its absorption, as well as glycine if you’re going the no-animals route. See: Collagen For Bones: We Are Such Stuff As Fish Are Made Of and: The Sweet Truth About Glycine: Making Your Collagen Work Better
• Consider medication, if your bone density is already lower than what it should be. There are meds to stop further deterioration, and different meds to encourage your body to rebuild bone. However, there are downsides to each of them: Which Osteoporosis Medication, If Any, Is Right For You?
• While we’re on the topic of medications, consider bioidentical HRT if you are female and not otherwise producing your own estrogen and progesterone in adequate quantities to maintain your skeletal integrity: HRT: A Tale Of Two Approaches
• Look after your gut too! So much starts there: Is Your Gut Leading You Into Osteoporosis? Bacterioides Vulgatus & Bone Health
• Lastly, exercise, but exercise right, because with insufficient resistance exercise your bones will not “think” they need to remain strong, and with the wrong kind of resistance exercise, you could break/compress your bones if they are already weak, so check out: Osteoporosis & Exercises: Which To Do (And Which To Avoid)

Too much information?

If that was too much information all at once, then we recommend this as your one-stop article:

The Bare-Bones Truth About Osteoporosis

Want more information?

We are but a humble newsletter and can only include so much per day, but we highly recommend this book we reviewed a little while back, which goes into everything in a lot more detail than we can here:

The Whole-Body Approach to Osteoporosis: How To Improve Bone Strength And Reduce Your Fracture Risk – by Keith McCormick

Enjoy!