**6. Bisphosphonate-added bone cement**

Bisphosphonates (BPs) are antiresorptive drugs widely used to treat bone diseases such as osteoporosis, bone metastases, and hypercalcemia of malignancy, to prevent bone loss, and to increase bone density [12, 13]. Several studies demonstrate that BPs with bone cement have effects on increasing mechanical property and reducing bone resorption.

BPs in combination with bone cement play a key role in mechanisms of reducing a risk of bone resorption. BP-enriched bone cement can regulate important mediators involved in osteoclas‐ togenesis, such as RANKL synthesis by osteoblast, and may modulate OPG, a decoy receptor of RANKL absorption, thus preventing RANK activation. In addition, two BPs alendronate and pamidronate mixed with calcium phosphate bone cement showed satisfactory results in mechanical properties. Both of them raise osteoblast proliferation and differentiation while restraining osteoclastogenesis and osteoclast function [14]. BP-combined cement can be a promising drug device as a local approach, preventing osteoporotic vertebral defect [13].

However, there is a paucity of clinical cases on clear efficacy of BP-laden bone cementoplasty and further studies are needed.
