"Bone Morphogenic Protein augmentation for long bone healing" response to "Clinical need for bone morphogenetic protein".

We take advantage of the comments of Dr. Vukicevic et al. to clarify that the study focus did not include other diseases and locations than long bones; in this light, the articles that Dr. Vukicevic mentioned could not be selected. We would like to recognize the key contribution of Urist and the nice tribute of the International Orthopaedics heritage section on the BMPs discovery. While we could not refer to the latter, published after our search, we put emphasis on the steps of important discoveries that made BMPs available for clinical use, a road that started in 1965, when Urist showed that new bone formation could be induced by demineralized bone matrix, later identified as BMPs, and purified in the next three decades. In the past years, BMPs have been studied in several pre-clinical models. As this was not the focus of this systematic clinical review, only some pre-clinical papers were cited, aiming at underlining important aspects, such as the relationship between dosage and bone formation and the delivery material, which could influence BMPs release and effect, key factors requiring further studies to optimize BMPs augmentation, as mentioned in the discussion. While our article does not present the methodological strength of a meta-analysis, and while it was not possible to summarize the entire extensive literature on BMPs, we hope that our review could be useful to summarize the available evidence in terms of both BMPs augmentation potential and complications for the treatment of long bones affected by fractures, non-union, and osteonecrosis.