A Literature Review of Commercially Available Demineralized Bone Matrix Products and Their Clinical Evidence in Acute Fractures, Nonunions, and Fusion Procedures

Michael Downing, OMS-III; Timothy Niedzielak, DO; Charles De La Rosa, OMS-II; Alexander Ting, OMS-II; Joshua Berko, OMS-III; Nicholas Lampasona, OMS-III; Brian Cross, DO


Curr Orthop Pract. 2021;32(2):197-203. 

In This Article

Abstract and Introduction


Demineralized bone matrix (DBM) is an allograft obtained from human cadaveric bone that has osteoinductive and osteoconductive properties. A wide array of specific DBM products is available, and each has its own biochemical, safety, and efficacy profiles. This study reviews comparison studies of brand-specific DBM products, including Allomatrix (Wright Medical Technology, Memphis, Tennessee), DBX (Depuy Synthes, Suchwil, Switzerland), Grafton (Osteotech, Eatontown, New Jersey), Orthoblast (Integra Orthobiologics, Plainsboro, New Jersey), and Osteosponge (Bacterin International, Belgrade, Montana), in an attempt to propose the most efficacious DBM product for bone grafting of various orthopaedic applications. Secondarily, we evaluate these specific DBM products in their potential use of tibial plateau fractures, which our future clinical research aims to achieve. A definitive gold-standard DBM product is lacking for orthopaedic use because of the scarcity of clinical research comparing specific brand products, limited study sample sizes, and lack of standardization in the creation of DBM products.Level of Evidence:Level III.


The past decade has seen an increase in the use of demineralized bone matrix (DBM) products for the use of fracture repair augmentation.[1] Reports from the U.S. alone show that DBM comprises about 50% of all allografts used in fracture care.[2] This is likely because of the relatively low cost, high availability, and the ease of use attributed to DBM.[3] Autologous bone grafting still remains the gold standard but has the disadvantages of intraoperative and postoperative complications such as increased surgical time, postsurgical donor site pain, and infection.[4] Safety and efficacy profiles vary between the abundance of DBM products, many of which have not been examined in the clinical setting. The literature has reported the various processing techniques for DBM products, including the demineralization, storage, and sterilization phases and how these lead to differences in efficacy.[4] Providers are tasked with selecting the appropriate DBM product that will provide the best outcomes for their patients. Therefore, a thorough review of the clinically tested DBM products is warranted to examine differences in outcomes among these products. To our knowledge, this is the first to examine these brand-specific products in an unbiased manner. This review aimed to evaluate specific DBM products within the clinical setting and compare safety and efficacy profiles in an effort to propose a gold standard DBM product that can be used for bone grafting in the setting of orthopaedic injuries.