Wednesday, July 3, 2013

What is Next in Osteoporosis Treatment?

Postmenopausal osteoporosis (low bone mass) is a huge global problem. The National Osteoporosis Foundation estimates that about one in two women over the age of 50 will break a bone due to osteoporosis. By 2020, half of all Americans over age 50 are expected to have low bone density.  A recent paper from the Musculoskeletal Research Program at the University of Aberdeen, UK reviewed the present and future drug treatments for osteoporosis.

While exercise is often prescribed for prevention and treatment many women end up taking drugs on a regular basis to prevent further bone loss.  The mainstay of drug treatment since 1995 are a class of drugs called oral bisphosphonates – such as Fosamax, Actonel, or Didronel.  These drugs have been shown to prevent loss of bone (resorption) but they need to be taken frequently and the side effects can include gastrointestinal upset or, more rarely, femoral fracture.  Bisphosphonates can also be administered intravenously.  A bone-building drug (as opposed to a loss-prevention drug) has also been available since 2002 (Forteo). This drug requires sub-cutaneous injection and frequent administration.  The latest addition to treatment is an anti-resorptive called demosumab (Prolia) which has a different mode of action than the bisphosphonates and requires only one subcutaneous injection every 6 months.  All of the above products are FDA approved for the treatment of osteoporosis.

There are number of very promising new products in the pipeline.  Among the most important is a class of drugs called anti-sclerostin antibodies.  These have been shown to be dramatically successful in mice and human trials are under way.

The bottom line of the paper from Aberdeen is that there are now several drug treatment options for osteoporosis that have been shown to be effective.  In the future, drugs with fewer side effects and less frequent administration are likely to be available. This will increase compliance and reduce the risk of fracture.

Read details of the paper here.

Monday, July 1, 2013

Hip Injuries in Female Rowers

Early morning rowers on the lake are a common sight in our hometown of Seattle. Most prior studies of rowing overuse injuries have focused on high rates of minor injuries to the lumbar spine, knee, wrist, and ribs. However, a recent paper in the journal Clinical Orthopaedics and Related Research examined injuries to the hip in adolescent and young adult rowers. In a retrospective review, clinicians from the Blue Ridge Bone and Joint Clinic, Asheville, NC, identified 21 hips in 18 rowers, mean age of 18.5 years, with significant hip joint pathology. Most of the patients (85%) were female prep school or collegiate rowers, and they exhibited isolated groin pain and physical findings consistent with impingement. Eighteen of the 21 hips (85%) eventually underwent arthroscopic surgery to repair labral tears and other pathology.  However, only 10 of the patients returned to rowing after surgery (2 were lost to follow-up). The authors believe that the mechanism of injury may be the repeated hyperflexion of the hip which compresses the hip as the seat slides up and the blade is placed in the water at the catch. The hips both go from extreme flexion to extension thousands of times during practice and competition.

The bottom line of this study is that rowing may cause significant overuse injury in the hip that can limit future participation in the sport.  If a rower has early signs of hip pain, she should proceed cautiously and seek qualified help from an orthopedic specialist. A young rower with a history of hip disorders should be particularly vigilant.

Read more about the study here.