As a bone cement in vertebroplasty and kyphoplasty, calcium phosphate cement (CPC) has several advantages over polymethylmethacrylate (PMMA) including biomcompatibility, biodegradability and osteoconductivity. However, its decay properties raise the risk of pulmonary embolism and consequent cardiovascular complications. Animal experiments have demonstrated that the disintegration of CPC forming more emboli, especially microemboli, causes more severe cardiovascular deterioration than PMMA. Current efforts focus on the incorporation of organic proteins or polymers into CPC to improve its stability in fluids, by enhancing the hydroxyapatite (HA) formation and reducing the fluid penetration. Silk fibroin (SF) can regular the mineralization process and bond with HA to form fibroin-HA nanocomposites with increased gelation properties. SF also has excellent biomechanical, biocompatible and biodegradable properties, and is convenient and inexpensive to produce. We hypothesize that silk fibroin can be used as an additive to improve the cohesion of CPC and decrease its risk of cardiovascular complications in its application in veterbroplasty/kyphoplasty.

Keywords: Pulmonary Embolism - etiology, Kyphoplasty - adverse effects, Fibroins - pharmacology, Cardiovascular Diseases - prevention & control, Calcium Phosphates - chemistry, Bone Cements - chemistry