The role of Vitamin D as an adjunct for bone regeneration: A systematic review of literature

Ramalingam Sundar; A Bhagavandas Rai; J Naveen Kumar; Darshan Devang Divakar

doi:10.1016/j.sdentj.2023.02.002

The role of Vitamin D as an adjunct for bone regeneration: A systematic review of literature

Saudi Dent J. 2023 Mar;35(3):220-232. doi: 10.1016/j.sdentj.2023.02.002. Epub 2023 Mar 1.

Authors

Ramalingam Sundar¹, A Bhagavandas Rai¹, J Naveen Kumar², Darshan Devang Divakar³

Affiliations

¹ Dept. of Oral and Maxillofacial Surgery, Pacific Dental College & Hospital, Pacific Academy of Higher Education and Research (PAHER) University, Udaipur, India.
² Dept. of Oral and Maxillofacial Surgery, Dental College and Hospital, Sri Ramachandra Institute of Higher Education and Research University, Chennai, India.
³ Dental Biomaterials Research Chair, King Saud University, Riyadh, Kingdom of Saudi Arabia; Dept. of Oral Medicine and Radiology, Faculty of Dentistry, Levy Mwanawasa Medical University (LMMU), Lusaka, Zambia.

Abstract

Background and objectives: In spite of bone's healing capacity, critical-size bone defect regeneration and peri-implant osseointegration are challenging. Tissue engineering provides better outcomes, but requires expensive adjuncts like stem cells, growth factors and bone morphogenic proteins. Vitamin D (Vit.D) regulates calcium and phosphorus metabolism, and helps maintain bone health. Vit.D supplements in deficient patients, accentuates bone healing and regeneration. Therefore the aim of this systematic review was to evaluate the role of adjunctive Vit.D on bone defect regeneration.

Methods: Comprehensive database search of indexed literature, published between January 1990 and June 2022, was carried out. English language articles fulfilling inclusion criteria (clinical/in vivo studies evaluating bone regeneration including osseointegration and in vitro studies assessing osteogenic differentiation, with adjunct Vit.D) were identified and screened.

Results: Database search identified 384 titles. After sequential title, abstract and full-text screening, 23 studies (in vitro - 9/in vivo - 14) were selected for review. Vit.D as an adjunct with stem cells and osteoblasts resulted in enhanced osteogenic differentiation and upregulation of genes coding for bone matrix proteins and alkaline phosphatase. When used in vivo, Vit.D resulted in early and increased new bone formation and mineralization within osseous defects, and better bone implant contact and osseointegration, around implants. Adjunct Vit.D in animals with induced systemic illnesses resulted in bone defect regeneration and osseointegration comparable to healthy animals. While systemic and local administration of Vit.D resulted in enhanced bone defect healing, outcomes were superior with systemic route.

Conclusions: Based on this review, adjunct Vit.D enhances bone defect regeneration and osseointegration. In vitro application of Vit.D to stem cells and osteoblasts enhances osteogenic differentiation. Vit.D is a potentially non-invasive and inexpensive adjunct for clinical bone regeneration and osseointegration. Long term clinical trials are recommended to establish protocols relating to type, dosage, frequency, duration and route of administration.

Keywords: Bone defect regeneration; Calcitriol; Cholecalciferol; Ergocalciferol; Osseointegration; Vitamin D.

Publication types

Review