Biomaterials 26 (2005) 6423–6429
Technological issues for the development of more efﬁcient calcium
phosphate bone cements: A critical assessment
, U. Gbureck
, J.E. Barralet
Dr Robert Mathys Foundation, Bischmattstrasse 12, CH-2544 Bettlach, Switzerland
Department of Functional Materials in Medicine and Dentistry, University of Wurzburg, Wurzburg, D-97070, Germany
Faculty of Dentistry, McGill University, Montre
al, Quebec, Canada H3A 2B2
Received 24 January 2005; accepted 24 March 2005
Available online 17 June 2005
The ﬁrst calcium phosphate cements (CPCs) were discovered in the 1980s. Two decades later, the interest for these materials is still
rising. The goal of the present document is to review the most recent achievements in the ﬁeld and to analyze future directions in
research and development.
r 2005 Elsevier Ltd. All rights reserved.
Keywords: Calcium phosphate cement; Vertebroplasty; Delivery; In vivo
Calcium phosphate cements (CPCs) are obtained by
mixing one or several reactive calcium phosphate powders
with an aqueous solution to form a paste that hardens
within a restricted period of time (e.g. 15 min). In that
respect, CPCs are different from traditionally used bone
substitutes such as granules and blocks which are not in a
paste form and do not sustain a rapid phase transition.
CPCs were proposed 2 decades ago by LeGeros et al.
, and Brown and Chow . The ﬁrst commercial CPC
products were introduced a decade ago for the treatment
of maxillo-facial defects and deformities  as well as for
the treatment of fracture defects . Now, companies
are introducing second-generation cements and are also
widening their portfolio to fulﬁl the various require-
ments of their customers (Table 1). For example,
brushite cements which have proved to be faster
resorbing than apatite cements in animal studies 
have entered the clinics. Other cements are designed for
one very speciﬁc application, i.e. cranioplasty or
These achievements have been possible due to the
considerable effort and large number of studies devoted
to CPCs. In fact, a few thousand papers have been
published so far and the publication rate increases
almost every year (Fig 1). The goal of the present article
is not to review most of the literature as has been done
by several authors in the past [6–9], but to give a brief
overview of the present achievements and to pinpoint
newest developments and trends.
2. Brief overview
Many discoveries and developments made in the ﬁeld
of CPCs stem from calcium silicate and sulphate-
based cements in the construction industry or from
ARTICLE IN PRESS
0142-9612/$ - see front matter r 2005 Elsevier Ltd. All rights reserved.
Editor’s Note: Leading Opinions: This paper is one of a newly
instituted series of scientiﬁc articles that provide evidence-based
scientiﬁc opinions on topical and important issues in biomaterials
science. They have some features of an invited editorial but are based
on scientiﬁc facts, and some features of a review paper, without
attempting to be comprehensive. These papers have been commis-
sioned by the Editor-in-Chief and reviewed for factual, scientiﬁc
content by referees.
Corresponding author. Tel.: +41 32 6441413; fax: +41 32 6441176.
E-mail address: Marc.email@example.com (M. Bohner).