Osteoporosis causes bones to weaken and break more easily, affecting about 10 million Americans. At Special Surgery, our doctors and scientists are developing clinical treatment protocols and examining the basic science behind the disease.
“At HSS, we see many patients who are unaware of their osteoporosis until they obtain a bone density test, or experience a fracture or impaired mobility,” explains Linda Russell, MD, attending rheumatologist and spearhead for osteoporosis intervention programs at HSS. “For these reasons we have focused our efforts on educating patients and identifying those at risk for osteoporosis, while halting disease progression.”
Special Surgery rheumatologists, surgeons, nurses, and scientists have developed a new clinical pathway of care for patients with osteoporosis. “This pathway will pull together the know-how and experience of various specialty areas to provide our patients with comprehensive assessment, diagnosis and treatment of osteoporosis,” explains Dr. Russell.
The Metabolic Bone Diagnosis and Treatment Service will identify patients with bone disease and those at risk, mapping the course for proper intervention and care while educating them in disease management. As a starting point, the program will enlist potential candidates for spinal fusion surgery.
Pre-surgical assessment by a physician-directed nurse practitioner will occur three to six months prior to surgery, and will include bone density, blood, and urine tests. Based on results, a healthcare team comprised of rheumatologists, spine surgeons, nurse practitioners, and related specialists will collectively devise a treatment plan for each patient leading up to surgery, with the goal of maximizing bone health to ensure the best surgical outcomes.
Dr. Russell and Richard Bockman, MD, PhD, chief of the Endocrine Service at HSS, are also involved in clinical trials designed to improve the quality of patients’ bones. Says Dr. Russell, “We plan to enroll our spine fusion patients in a registry and periodically review the collected data to determine trends and evaluate how we’re doing. Through research, we can enhance treatment.”
In the laboratory, HSS scientists study the causes of bone disease. Investigators say that the development of effective treatments requires a better understanding of how healthy bone forms and changes with age. “Biology will become increasingly important in the study and treatment of orthopedic disease,” says Adele Boskey, PhD, Starr Chair, Mineralized Tissue Research at HSS and renowned investigator of osteoporosis.
Current investigations at HSS concentrate on bone biology, chemistry, and the mechanics of bone growth, including how to harness bone’s natural healing power to prevent fracture and treat diseased bone. Through this research, Dr. Boskey, orthopedic surgeon Joseph Lane, MD, and biomechanical engineer Marjolein van der Meulen, PhD, have defined new predictors of fracture risk.
Drs. Boskey, Lane, and colleagues are also investigating the long-term effects of bisphosphonate drugs, which suppress the natural process in which bone tissue is removed and replaced with new bone. One of the most successful categories of drugs in preventing fracture, bisphosphonates are typically prescribed to strengthen bones, but recent investigations have found that these medications given long term may actually elevate fracture risk in some patients.
For patients who require surgery, studies point to the benefits of raising levels of vitamin D – essential for bone healing and muscle function – prior to an orthopedic procedure. Dr. Lane and colleagues found that nearly half of patients undergoing surgery have vitamin D deficiency, which can impair recovery. In these cases, vitamin D levels should be brought up to normal levels before surgery. “Since bone tissue formation is active around two to four weeks after surgery,” says Dr. Lane, “the body needs vitamin D at this time.”
HSS investigators and clinicians hope to reduce the more than 1.5 million fractures that are caused by osteoporosis each year.
Learn more in HSS's biannual publication, Discovery to Recovery.