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Antibacterial bioactive glass to fight chronic bone infections in orthopaedics

BonAlive® granules is a bacterial growth inhibiting technology that provides new tools in fighting antibiotic resistance and the increasing problems involving orthopaedic infections.


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Bioactive glass for the adjunctive treatment of chronic osteomyelitis of the long bones




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VIDEO: Antibacterial Bioglass Preparation


What is bioactive glass ?

Chronic osteomyelitis, or chronic bone infection, is defined and characterized by progressive infection of the bone marrow and cortex. Bone infections, which are typically associated with severe bone loss, represent one of the most complex and difficult-to-treat pathologies in orthopaedics. They may occur at any age and can involve any bone.

Often, a multidisciplinary approach is required, involving expertise in orthopaedic surgery, infectious diseases and plastic surgery to treat the bone infection. There are many situations that can lead to critical situations of bone infection and the resolution of such complications usually need special medical solutions. These problems have been traditionally solved with intensive use of local antibiotics, but recent discoveries have shown that antibacterial bioactive glass can effectively be used in fighting chronic bone infections in orthopaedics.



Antibacterial bioactive glass S53P4 

It is a pioneering and highly innovative approach to use bioactive glass S53P4 for the treatment of chronic bone infections. Bioactive glass S53P4 is a resorbable and fully synthetic biomaterial with the composition: 53% SiO2, 23% Na2O, 20% CaO, 4% P2O5 (manufactured as BonAlive® granules by BonAlive Biomaterials Ltd in Turku, Finland).


One of the most striking features of bioactive glass S53P4 is its ability to inhibit bacterial growth. This phenomenon has been evidenced on a wide range of clinically relevant aerobic and anaerobic bacteria species through in vitro studies1-4, and indirectly by empirical observation of patient data over the past 15 years5,6. Bioactive glass S53P4 is the world’s first and only resorbable biomaterial for bone regeneration that can also inhibit bacterial growth without the use of local antibiotics. This makes the bioactive glass S53P4 a powerful tool for the treatment of bone cavities derived from chronic bone infections.


Mechanism of action

The bacterial growth inhibiting effect of bioactive glass S53P4 is based on the combined effect of two simultaneous processes that occur when the material reacts with body fluids in a bone defect:

1) Sodium is released from the surface of the bioactive glass, which induces an elevation of the pH and this is not favourable for the bacteria.

2) Ions (of Na, Ca, P and Si) which are released from the surface give rise to an increase in osmotic pressure, i.e. an environment where the bacteria cannot grow.


Bioactive glass S53P4 for the treatment of chronic osteomyelitis

Chronic bone infections play a large role in surgery as the infection is hard to eradicate and might require several operations. Bioactive glass S53P4 has been proven effective for bone cavity filling in the treatment of chronic osteomyelitis8-10. In cases where the cavitary defect allows sufficient debridement of the necrotic tissues, it can also be successfully used in a one-stage-procedure to fill the dead space. The positive clinical effect of bone regeneration is seen through the combined effect of the product’s bacterial growth inhibiting, bioactive and bone growth promoting properties. 


Key benefits 

  • Capacity of simultaneous bacterial growth inhibition and stimulation of bone regeneration
  • Only rarely seroma leakage from the wound
  • No local antibiotic needed (systemic antibiotics should be given according to normal clinical practice)
  • No development of resistance towards bacteria
  • Is effective towards more than 50 most common bacteria strains (incl. MRSA, MRSE)


Official indication

  • Bone cavity filling in the treatment of chronic osteomyelitis (indication approved only in EU)




  1. Antibacterial effects and dissolution behavior of six bioactive glasses. Zhang D, Leppäranta O, Munukka E, Ylänen H, Viljanen MK, Eerola E, et al. J Biomed Mater Res. 2010;93A(2):475-83.
  2. Bactericidal effects of bioactive glasses on clinically important aerobic bacteria. Munukka E, Leppäranta O, Korkeamäki M, Vaahtio M, Peltola T, Zhang D, et al. J Mater Sci: Mater Med. 2008;19:27-32.
  3. Antibacterial effect of bioactive glasses on clinically important anaerobic bacteria in vitro. Leppäranta O, Vaahtio M, Peltola T, Zhang D, Hupa L, Ylänen H, et al. J Mater Sci: Mater Med. 2008;19:547-551.
  4. Factors controlling antibacterial properties of bioactive glasses. Zhang D, Munukka E, Hupa L, Ylänen H, Viljanen MK, Hupa M. Key Engineering Materials. 2007;330-332:173-176.
  5. Bioactive glass S53P4 in mastoid obliteration surgery for chronic otitis media and cerebrospinal fluid leakage. Sarin J, Grénman R, Aitasalo K, Pulkkinen J. Annals of Otology, Rhinology & Laryngology. 2012;121:563-569.
  6. Bioactive glass S53P4 in frontal sinus obliteration: A long-term clinical experience. Peltola M, Aitasalo K, Suonpää J, Varpula M, Yli-Urpo A. Head and Neck. 2006;28(9):834-841.
  7. Molecular basis for action of bioactive glasses as bone graft substitute. Välimäki VV, Aro HT. Scandinavian Journal of Surgery. 2006;95(2):95-102
  8. Bioactive glass S53P4 as bone graft substitute in treatment of osteomyelitis.Lindfors NC, Hyvönen P, Nyyssönen M, Kirjavainen M, Kankare J, Gullichsen E, Salo J. Bone. 2010;47:212-218.
  9. Bioactive glass for the treatment of cavitary defects in osteomyelitis. A retrospective comparative study. C. L. Romanò, G. Manzi, M. Calamita, N. Logoluso. E-poster, EFORT 2012, Berlin Germany.
  10. Through the looking glass; bioactive glass S53P4 (BonAlive®) in the treatment of chronic osteomyelitis. McAndrew, J, Efrimescu, C, Sheehan, E, Niall, D. Irish journal of medical science. 2013.



Visit also: Bonalive Biomaterials Ltd., Finland





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