Friday, March 2, 2001
Advances in pharmacologics could have a major impact on treatment for orthopaedic conditions, researchers said at a press conference Wednesday.
Of wide interest was the progress in research on growth factors, which could speed fracture healing and spinal fusions by prompting the body to grow bone tissue.
First, and foremost, however, the growth factors will be useful in negating the need for bone grafts. Instead of risking the complication-ridden procedure, orthopaedists will be able to simply inject growth factors at sites that need new bone.
"It's better for the patient and for the surgeon," said R. Tracy Ballock, MD, associate professor of orthopaedics and pediatrics, Case Western Reserve University in Cleveland.
Eventually, growth factor-based agents can be developed to treat common bone fractures, which could decrease the normal healing time from six weeks to five. This will be especially useful in treating tibial fractures, which are typically difficult to heal, he said.
Companies testing growth factors, have yet to receive the green light from the Food and Drug Administration, however. Dr. Ballock estimates that the first growth-factor products, several of which are now in phase three clinical trials, will be approved within two years.
Nutritional supplements chondroitin and glucosamine sulfate were also the subject of discussion. Though scientific evidence of their effectiveness is lacking, what little exists shows that the supplements could indeed help to decrease inflammation and pain in joints, said Joseph M. Lane, MD, professor of orthopaedic surgery and assistant dean of medical students, Cornell University Medical College in New York.
"I'm convinced, from reviewing the literature, that patients are better off [with the supplements]," Dr. Lane said.
As with most nutritional supplements, however, the lack of FDA oversight leaves physicians still wondering how chondroitin and glucosamine sulfate work and about their safety and possible side effects.
Researchers are also looking into hyaluronic acid medications, sold under brand names Synvisc and Hyaluron. Though they've long been used as a joint lubricant, evidence is showing that the drugs could stimulate some kind of beneficial long-term effect, Lane said.
Also under the microscope are Cox-2 inhibitors, such as anti-inflammatory medications Celebrex and Vioxx. Patients using the drugs, instead of the traditional non-steroidal anti-inflammatory drugs, have less of a chance of suffering from the well-known side effects of gastrointestinal bleeding and indigestion. However, new research is showing that high doses of the Cox-2 drugs could inhibit fracture healing.
In addition, Lane mentioned the Academy's intensive program to educate orthopaedists to treat disease. To demonstrate the need, he noted that only 15 percent of orthopaedists appropriately treated their elderly fracture patients with bisphosphonates. After encouraging orthopaedic residents and attending physicians at Cornell, the number of prescriptions increased three times. He also encouraged the orthopaedists to give their patients advice on taking calcium and vitamin D supplements and other suggestions on caring for osteoporosis.
"The medical side-geriatricians and rehabilitation physicians-isn't prescribing [antiresorptive therapy]," he said. "We have to do it ourselves."
|2001 Academy News March 2 Index A|
Last modified 02/March/2001 by IS