Adjuvants alter the setting behavior of a ceramic bone graft substitute: implications for the laboratory and operating room
Hydroxyapatite-calcium sulfate (HACaS) bone cements have been clinically established. Combining HACaS with an antiresorptive (zoledronic acid, ZA) and osteoanabolic agent (bone morphogenic protein 2; BMP-2) may enhance the performance of HACaS bone cements in challenging indications, but it must be...
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| Main Authors: | , , , , , , |
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| Format: | Article (Journal) |
| Language: | English |
| Published: |
1 May 2026
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| In: |
Materials
Year: 2026, Volume: 19, Issue: 9, Pages: 1-12 |
| ISSN: | 1996-1944 |
| DOI: | 10.3390/ma19091873 |
| Online Access: | Verlag, kostenfrei, Volltext: https://doi.org/10.3390/ma19091873 Verlag, kostenfrei, Volltext: https://www.mdpi.com/1996-1944/19/9/1873 
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| Author Notes: | Felix Lamadé-Dootz, Nick Mattern, Sanja Kalmus, Alma Aubert, Paul Alfred Grützner, Jonas Armbruster and Holger Freischmidt |
| Summary: | Hydroxyapatite-calcium sulfate (HACaS) bone cements have been clinically established. Combining HACaS with an antiresorptive (zoledronic acid, ZA) and osteoanabolic agent (bone morphogenic protein 2; BMP-2) may enhance the performance of HACaS bone cements in challenging indications, but it must be ensured that this does not impair their setting and mechanical properties. This study established a Vicat/Gillmore-inspired indentation protocol to quantify force-based endpoints and the setting of HACaS with biological adjuvants. HACaS was mixed with or without ZA and/or BMP-2 at 0 min and after a 2 min pre-setting phase with reduced NaCl content (lower liquid-to-powder ratio). For each time point (3-90 min), three cylindrical pellets (Ø 4 mm, height 6 mm) underwent single indentation. Setting was defined as the maximum force at needle penetration, and endpoint hardness was defined as peak force at failure. For 24 h endpoints, specimens were incubated in blood at 37 °C. One-way ANOVA with Tukey’s H post hoc test was performed per time point (n = 3; 24 h endpoints n = 5). All 2 min protocols showed accelerated setting, consistent with the initial lower liquid-to-powder ratio. ZA significantly delayed setting and remained lowest at 90 min and after 24 h in blood. Mixing sequence and vehicle composition critically influenced early mechanical properties and should be considered in the further preclinical evaluation of HACaS with osteoanabolic or antiresorptive agents. |
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| Item Description: | Gesehen am 26.06.2026 |
| Physical Description: | Online Resource |
| ISSN: | 1996-1944 |
| DOI: | 10.3390/ma19091873 |