Calcium–strontium mixed phosphate as novel injectable and radio-opaque hydraulic cement

Sterile calcium hydrogenophosphate dihydrate (DCPD) (CaHPO4·2H2O), calcium oxide and strontium carbonate powders were mixed in various liquid phases. Among these, ammonium phosphate buffer (0.75 M, pH 6.9) led to a novel strontium-containing calcium phosphate cement. At a 6/2.5/1.5 M ratio and for a liquid to powder ratio (L/P) of 0.5 ml g−1, the initial paste was fluid and remained injectable for 12 min at 25 °C. It was easily obtained by mixing sterile powders and the liquid phase using the push–pull technique, avoiding complex mixing apparatus. The cement set after 15 min at 37 °C and was hard after 1 h. The compressive strength was in the 20 MPa range, a value higher than that generally assigned to trabecular bone (5–15 MPa). This strength appeared sufficient for repairing non-loading sites or reinforcing osteoporotic vertebrae (vertebroplasty). After setting, the initial mixture formed a strontium–calcium-deficient carbonate apatite. The radio-opacity of the resulting cement was three times greater than that of cortical bone because of the presence of strontium ions, a feature that complies with the requirements for vertebroplasty. Furthermore, the cement powder remained stable and retained its properties for at least 4 years.